Istanbul University, Faculty of Medicine, Department of Otolaryngology, Istanbul, Turkey.
Koç University, School of Medicine, Department of Otolaryngology, Istanbul, Turkey.
Braz J Otorhinolaryngol. 2022 Mar-Apr;88(2):174-180. doi: 10.1016/j.bjorl.2020.05.013. Epub 2020 Jun 15.
Posterior pharyngeal wall is the most rare subsite for hypopharyngeal carcinomas. Because of its rarity, there are few studies published in the literature specifically concerning posterior pharyngeal wall carcinoma.
To report our functional results in patients with the carcinoma of the posterior wall of the hypopharynx after surgical treatment by resection via a lateral or infrahyoid pharyngotomy approach, with the preservation of the larynx and reconstruction with a radial forearm free flap.
The study included 10 patients who underwent surgery for a carcinoma of the posterior wall of the hypopharynx over a 6 year period. The associated postoperative morbidity was investigated and functional results were analyzed.
Nine patients had T3 lesions and one patient had a T2 lesion. The preferred approach to access the hypopharynx was a lateral pharyngotomy in 5 patients and lateral pharyngotomy combined with infrahyoid pharyngotomy in 5 patients with superior extension to oropharynx. The pharyngeal defects were reconstructed successfully with radial forearm free flaps. Four patients received adjuvant radiotherapy only, and 4 patients with N2b and N2c neck diseases received adjuvant chemoradiotherapy. The mean duration of hospitalization was 15.6 days (range, 10-21 days). All patients achieved oral intake in a median time of 74 days (range, 15-180). Decannulation was achieved in all patients and the median time for decannulation was 90 (range, 21-300 days). The mean followup duration was 38.3 months (range, 10-71 months) and 8 patients survived. One patient died due to regional recurrence in the retropharyngeal lymph nodes and 1 patient died due to systemic metastasis.
Primary surgery is still a very effective treatment modality for the carcinoma of the posterior wall of the hypopharynx and does not permanently compromise the swallowing and laryngeal functions if pharyngeal reconstruction is performed with a free flap.
咽后壁是下咽癌中最罕见的部位。由于其罕见性，文献中很少有专门针对咽后壁癌的研究。
报告我们通过侧方或下咽经胸骨舌骨肌切开术进行手术切除，并保留喉，使用游离前臂皮瓣重建，治疗下咽后壁癌患者的功能结果。
本研究纳入了在 6 年期间接受下咽后壁癌手术的 10 例患者。研究调查了术后相关发病率，并对功能结果进行了分析。
9 例患者为 T3 病变，1 例患者为 T2 病变。5 例患者采用侧方咽切开术，5 例患者采用侧方咽切开术联合下咽经胸骨舌骨肌切开术，对咽后肿瘤向上累及口咽的患者采用该术式。成功使用游离前臂皮瓣重建咽腔缺损。4 例患者仅接受辅助放疗，4 例 N2b 和 N2c 颈部疾病患者接受辅助放化疗。平均住院时间为 15.6 天（范围，10-21 天）。所有患者均在中位数 74 天（范围，15-180 天）恢复经口进食。所有患者均实现了拔管，拔管中位数时间为 90 天（范围，21-300 天）。平均随访时间为 38.3 个月（范围，10-71 个月），8 例患者存活。1 例患者因咽后淋巴结区域性复发死亡，1 例患者因全身转移死亡。
如果使用游离皮瓣进行咽重建，原发性手术仍然是治疗下咽后壁癌的非常有效的治疗方法，并且不会永久损害吞咽和喉功能。
