Lancini Davide, Montenegro Claudia, Mattavelli Davide, Grammatica Alberto, Rampinelli Vittorio, Zigliani Gabriele, Piazza Cesare
Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy.
Department of Surgical and Medical Specialties, Radiological Sciences and Public Health, University of Brescia, School of Medicine, Brescia, Italy.
Acta Otorhinolaryngol Ital. 2024 Dec;44(6):361-367. doi: 10.14639/0392-100X-N3071. Epub 2024 Sep 15.
Lateral hypopharyngectomy (LH) is one of the organ-preservation surgical strategies available for treatment of selected naïve early squamous cell carcinoma (SCC), as well as for rarer non-SCC tumours and persistent/recurrent/second primaries after chemoradiation of the lateral wall of the piriform sinus. Its reconstructive methods have been the subject of different approaches without a general consensus. The aim of the present study is to describe a retrospective series of LH reconstructed by inlay fascio-cutaneous free flaps, reporting on oncological and functional outcomes.
Patients who underwent LH at the Department of Otorhinolaryngology - Head and Neck Surgery of the University of Brescia, Italy, between 2017 and 2023 were retrospectively reviewed. Clinical history, tumour histotype, postoperative complications, functional, and oncological outcomes were collected.
Seven patients (6 males, 1 female) were included. In all, 29% had a treatment-naïve neoplasm, while 71% had recurrent disease. The final histology included 3 SCC, 2 synovial sarcomas, one liposarcoma, and one single-site mucosal metastasis from cutaneous melanoma. Negative margins were achieved in 6 patients (86%). All patients had swallowing rehabilitation by speech therapists and were able to safely eat a free diet at discharge, except for one who needed a percutaneous endoscopic gastrostomy to support nutritional oral intake. After a mean follow-up of 34.3 months, all patients except one are alive.
Our study showed that, in selected cases, it is possible to radically remove lateral hypopharyngeal tumours with laryngeal preservation and free flaps inlay reconstruction, with a low rate of complications and acceptable functional and oncological results.
下咽外侧切除术（LH）是一种保留器官的手术策略，可用于治疗部分初治早期鳞状细胞癌（SCC），以及治疗较罕见的非SCC肿瘤和梨状窦外侧壁放化疗后出现的持续性/复发性/第二原发性肿瘤。其重建方法一直是不同方法的研究对象，尚未达成普遍共识。本研究的目的是描述一组采用镶嵌式筋膜皮瓣游离皮瓣重建的LH回顾性病例系列，报告肿瘤学和功能结局。
对2017年至2023年期间在意大利布雷西亚大学耳鼻咽喉头颈外科接受LH手术的患者进行回顾性研究。收集患者的临床病史、肿瘤组织学类型、术后并发症、功能和肿瘤学结局。
纳入7例患者（6例男性，1例女性）。其中，29%为初治肿瘤，71%为复发性疾病。最终组织学检查包括3例SCC、2例滑膜肉瘤、1例脂肪肉瘤和1例皮肤黑色素瘤的单部位黏膜转移。6例患者（86%）切缘阴性。所有患者均接受了言语治疗师的吞咽康复训练，除1例需要经皮内镜下胃造瘘以支持经口营养摄入外，其余患者出院时均能安全进食普通饮食。平均随访34.3个月后，除1例外，所有患者均存活。
我们的研究表明，在特定病例中，采用保留喉的游离皮瓣镶嵌重建术可根治性切除下咽外侧肿瘤，并发症发生率低，功能和肿瘤学结果可接受。
