Liposarcoma of the hypopharynx

A case of the unusual condition of liposarcoma of the hypopharynx extending submucosally down the oesophagus in a 64 year old male is reviewed. The clinical, radiological and pathological features are presented and the role of various radiological modalities is discussed.     

可视喉镜在喉咽异物取出术中的应用

目的探讨可视喉镜下取出难治性喉咽异物的可行性。方法回顾性分析我科2016年1月~2019年1月经电子喉镜或喉X线正侧位片诊断为喉咽异物的住院患者27例,所有患者在全麻可视喉镜下经喉显微钳顺利取出异物,其中异物位于梨状窝者12例,其中9例为鱼刺,3例为鸭骨头;位于环后区者15例,均为1元或5角硬币。结果所有患者术中暴露良好,经喉显微钳顺利取出异物,麻醉过程中无心血管事件发生,无喉咽黏膜损伤、门齿松动、伤口感染等并发症。结论可视喉镜能很好地暴露喉咽,配合合适的喉显微器械能够顺利取出喉咽异物,安全可行,具有一定的创新性和独特的优势。     

Total pharyngolaryngectomy for squamous cell carcinoma of the hypopharynx: a review

OBJECTIVES: To evaluate our experience with total pharyngolaryngectomy in the treatment of hypopharyngeal squamous cell carcinoma. STUDY DESIGN: Retrospective analysis of consecutively treated patients in an academic otolaryngology, head and neck department. METHODS: One hundred eighty patients who had total pharyngolaryngectomy performed for hypopharyngeal carcinoma were included in this study. Patients with a history of previous head and neck cancer were excluded. Clinicopathologic parameters were recorded and survival calculated using the Kaplan-Meier method. RESULTS: One hundred sixty-two (90%) of the patients were male, and the patients had a mean age of 62 years. The majority (91%) of patients had advanced overall clinical stage disease (stage 3,4). Thirty-one (17.8%) and 43 (24%) patients developed locoregional and metastatic disease recurrence, respectively. The 2- and 5-year disease-specific survival rates were 72% and 52%, respectively. Advanced nodal stage, perineural invasion, lymphovascular invasion, and positive margins were predictors of poor survival on univariate analysis, and lymphovascular invasion was an independent prognostic factor on multivariate analysis. CONCLUSION: Surgery and postoperative radiotherapy remains the treatment against which other modalities should be compared for advanced stage hypopharyngeal squamous cell carcinoma.     

Reconstruction after resection of hypopharyngeal carcinoma: comparison of the postoperative complications and oncologic results of different methods

BACKGROUND: Radical surgery followed by radiotherapy plays an important role in the treatment of patients with hypopharyngeal cancer. However, there is no general consensus as to which is the best method of reconstruction after surgical resection. METHODS: We retrospectively reviewed the records of 91 patients who underwent radical surgery and reconstruction. Postoperative complications and oncologic results of the different reconstructive methods were compared. RESULTS: Reconstruction with gastric pull-up had the lowest pharyngocutaneous (PC) fistula (0%) and pharyngoesophageal (PE) stenosis rates (0%). However, the overall postoperative complication rate was high (64%). Laryngotracheal flap (LTF) reconstruction had relatively lower rates of PC fistula (3%), PE stenosis (10%), and overall complications (22%). The introduction of the LTF technique significantly decreased postoperative complications from 71% to 30% (p = .0001), with similar tumor control and survival. CONCLUSIONS: Hypopharyngeal reconstruction with an LTF is a simple and effective method. The chance of using a complex flap is decreased. The postoperative complications are reduced, and the oncologic results are satisfactory.     

Functional results with advanced hypopharyngeal carcinoma treated with circular near-total pharyngolaryngectomy and jejunal free-flap repair

BACKGROUND: Patients treated by a circular pharyngolaryngectomy for advanced hypopharyngeal carcinoma have a poor prognosis and disappointing speech restoration. METHODS: Three carefully selected patients underwent a near-total laryngectomy circular pharyngectomy with jejunal free flap repair and dynamic tracheopharyngeal shunt for treatment of advanced hypopharyngeal carcinoma. They received induction chemotherapy and postoperative radiotherapy. We assessed the functional outcome. RESULTS: There was no major local complication. One year after the end of radiotherapy, all patients were able to eat solid diets. Two patients were able to speak immediately after the end of the treatment. After speech re-education, a high-quality tracheopharyngeal voice was restored in all three patients. Performance Status Scale for Head and Neck Cancer Patients (PSSHN) showed a mean score equal to 81/100 at 1 year. CONCLUSIONS: In selected patients, near-total laryngectomy circular pharyngectomy with tracheopharyngeal shunt and jejunal free-flap repair offers good voice rehabilitation without impairing swallowing function.