Ospedali Riuniti Padova Sud, Madre Teresa Di Calcutta, ENT Surgery, Via Albere 30, Monselice, 35043, Padua, Italy.
Department of Otolaryngology, Head and Neck Surgery (P.D., M.G.), Civil Hospital, Via Giovanni Borea, 56, Sanremo, 18038, Imperia, Italy.
Eur Arch Otorhinolaryngol. 2020 Aug;277(8):2375-2380. doi: 10.1007/s00405-020-06009-4. Epub 2020 May 4.
Early persistent/recurrent hypopharyngeal tumours represent a challenge for surgeons who have to balance the need for oncological radicality and the desire to maintain a functioning larynx with preservation of the patient's quality of life. The aim of this study was primarily to understand the technical feasibility, functional outcomes, and the possibility of obtaining oncological radicality using lateral hypopharyngectomy with laryngeal preservation in early recurrent post-radio/(chemo)therapy hypopharyngeal tumours.
Patients with recurrent T1 hypopharyngeal squamous cell carcinoma were retrospectively selected from our institutional database. The external lateral approach according to Spriano and a modified lateral hypopharyngectomy with laryngeal preservation were used to resect tumours of the lateral pyriform sinus wall. Reconstruction was obtained by direct approximation of the posterior border of the sectioned thyroid cartilage to the posterior hypopharyngeal wall, and this was reinforced with a second layer of vascularised and non-irradiated tissue that was provided by a microvascular fascial anterobrachial flap. Swallowing was assessed 3 weeks after surgery using videoendoscopic evaluation.
The surgical procedure was technically feasible, and complete resection was obtained in all patients. None of the patients experienced major post-operative complications (salivary fistula, bleeding, aspiration pneumonia). Mild dysphagia was observed in one patient who underwent swallowing rehabilitation. Tracheostomy was closed in all patients. No recurrence was recorded after a median follow-up of 20 months.
The reported experience shows that, in selected cases, it is possible to radically remove lateral hypopharyngeal cancer with acceptable functional results.
早期持续性/复发性咽下部肿瘤对外科医生来说是一个挑战，他们必须平衡肿瘤根治的需要和保留患者生活质量的愿望，同时保持喉的功能。本研究的主要目的是了解使用保留喉的外侧咽下部切除术治疗早期复发性放/（化）疗后咽下部肿瘤的技术可行性、功能结果和获得肿瘤根治的可能性。
从我们的机构数据库中回顾性选择复发性 T1 咽下部鳞状细胞癌患者。根据 Spriano 的方法采用外部外侧入路和改良的保留喉的外侧咽下部切除术切除外侧梨状窦壁的肿瘤。重建是通过直接将切开的甲状软骨后缘与咽下部后壁接近来实现的，并用微血管筋膜前臂皮瓣提供的第二层血管化和未照射的组织来加强。术后 3 周通过视频内镜评估来评估吞咽情况。
手术程序在技术上是可行的，所有患者均获得了完全切除。没有患者出现严重的术后并发症（涎瘘、出血、吸入性肺炎）。一名接受吞咽康复治疗的患者出现轻度吞咽困难。所有患者的气管造口均关闭。在中位数为 20 个月的随访中，没有记录到复发。
报告的经验表明，在选择的病例中，有可能通过可接受的功能结果根治性地切除外侧咽下部癌。
