Lateral conservative approach for recurrent/persistent hypopharyngeal carcinoma: a case series

Purpose Early persistent/recurrent hypopharyngeal tumours represent a challenge for surgeons who have to balance theneed for oncological radicality and the desire to maintain a functioning larynx with preservation of the patient’s quality oflife. The aim of this study was primarily to understand the technical feasibility, functional outcomes, and the possibility ofobtaining oncological radicality using lateral hypopharyngectomy with laryngeal preservation in early recurrent post-radio/(chemo)therapy hypopharyngeal tumours.Methods Patients with recurrent T1 hypopharyngeal squamous cell carcinoma were retrospectively selected from our institutionaldatabase. The external lateral approach according to Spriano and a modified lateral hypopharyngectomy withlaryngeal preservation were used to resect tumours of the lateral pyriform sinus wall. Reconstruction was obtained by directapproximation of the posterior border of the sectioned thyroid cartilage to the posterior hypopharyngeal wall, and this wasreinforced with a second layer of vascularised and non-irradiated tissue that was provided by a microvascular fascial anterobrachialflap. Swallowing was assessed 3 weeks after surgery using videoendoscopic evaluation.Results The surgical procedure was technically feasible, and complete resection was obtained in all patients. None of thepatients experienced major post-operative complications (salivary fistula, bleeding, aspiration pneumonia). Mild dysphagiawas observed in one patient who underwent swallowing rehabilitation. Tracheostomy was closed in all patients. No recurrencewas recorded after a median follow-up of 20 months.Conclusion The reported experience shows that, in selected cases, it is possible to radically remove lateral hypopharyngealcancer with acceptable functional results.