[Therapy of hypopharyngeal carcinoma. Part V: Discussion of long-term results of transoral laser microsurgery of hypopharyngeal carcinoma].

The results of transoral laser microsurgery of hypopharyngeal carcinomas have been described in previous publications. These are discussed on the basis of literature reports on the therapy used, inclusive of surgery and/or radiotherapy and/or chemotherapy. The most important parameters of prognosis include neck and distant metastases as well as multiple tumors. In analysing results of laser therapy, prognosis has been better compared to conventional types of therapy regarding loco-regional control and survival rates. Surgical overtreatment in the sense of pseudoradicality, especially when sacrificing parts of the larynx not involved by tumor, is compared to precision surgery employing the operative microscope and the laser. The latter, presupposing the necessary experience and complying with certain precautions, offers high oncological safety in resection of the primary tumor while at the same time preserving functionally important organic structures. The difficulties arising from a comparative assessment of therapeutic results are dealt with in detail. In terms of radiobiology, radiotherapy is generally given early (after about 2 weeks) in regions well supplied with blood and has been found to be very effective. Local immunologic factors concluding minimally-invasive surgery in the neck) can also be responsible for a favorable clinical course of disease, as can psycho-oncological aspects (quick functional rehabilitation as well as reintegration into job and family). The generally accepted, but probably outdated, guidelines for conventional head and neck surgery demanding extremely radical surgery of primary tumors, block resections, etc. must be critically revised.(ABSTRACT TRUNCATED AT 250 WORDS)