Department of Head and Neck Surgery National Cancer Center Hospital East, Chiba, Japan.
Department of Plastic and Reconstructive Surgery National Cancer Center Hospital East, Chiba, Japan.
Jpn J Clin Oncol. 2019 Oct 1;49(10):919-923. doi: 10.1093/jjco/hyz091.
Hypopharyngeal cancers frequently go undetected until advanced stages. However, recent advances in endoscopic technology have enabled earlier detection of hypopharyngeal cancer. We evaluated the effectiveness of larynx-preserving surgery for hypopharyngeal cancer.
We retrospectively analyzed 99 patients with hypopharyngeal squamous cell carcinoma who underwent partial hypopharyngectomy with larynx preservation between September 1992 and December 2009 at the National Cancer Center Hospital East. Of these, 91 patients underwent larynx-preserving surgery as initial treatment; eight patients underwent salvage surgery for recurrent disease after previous radiotherapy. Also, 9 of our patients had undergone previous radiotherapy in the head and neck for a different cancer. Before surgery, the TNM stage and tumor location was recorded. Free-flap reconstruction was performed in 60 patients, while the hypopharyngeal mucosa was closed without a free flap in 39 patients.
The 5-year overall survival rate in our cohort was 66.9%, and 59 patients are currently alive without recurrence. Thirty-three patients died due to primary recurrence (n = 5), regional recurrence (n = 10), distant metastasis (n = 9), postoperative death (n = 1), and unrelated disease (n = 8). Laryngeal function could not be preserved in 19 patients, 2 of whom had undergone previous radiotherapy, and 7 of whom had undergone both previous radiotherapy and other salvage surgeries.
Partial hypopharyngectomy can preserve laryngeal function in patients with pharyngeal cancer with careful patient selection.
下咽癌通常在晚期才被发现。然而，内镜技术的最新进展使下咽癌的早期发现成为可能。我们评估了保留喉功能的下咽癌手术的疗效。
我们回顾性分析了 1992 年 9 月至 2009 年 12 月在国立癌症中心医院东院接受部分下咽切除术保留喉功能的 99 例下咽鳞癌患者。其中 91 例为初治保留喉功能手术，8 例为既往放疗后复发的挽救性手术。此外，我们的 9 例患者因头颈部的其他癌症曾接受过放疗。手术前记录了 TNM 分期和肿瘤位置。60 例患者行游离皮瓣重建，39 例患者无游离皮瓣行下咽黏膜关闭。
本队列的 5 年总生存率为 66.9%，59 例患者目前无复发且存活。33 例患者因原发复发（n=5）、区域复发（n=10）、远处转移（n=9）、术后死亡（n=1）和无关疾病（n=8）而死亡。19 例患者未能保留喉功能，其中 2 例曾接受过放疗，7 例曾接受过放疗和其他挽救性手术。
仔细选择患者，部分下咽切除术可保留下咽癌患者的喉功能。
