[Preservative surgery of medial wall pyriform sinus cancer]

To study the surgical methods and functional outcome of preservative surgery for medial wall pyriform sinus cancer.

Seventy-one patients with medial wall pyriform sinus cancer, who were treated surgically between 1985 and 1997, were reviewed. Of the 71 cases, 49 underwent preservative surgery, and 22 total laryngectomy. Preservative surgical procedure was defined as follows: 1. Extent of resection: Supraglottic horizontal partial laryngectomy and resection of medial wall of pyriform sinus were performed in patients without fixation of the true vocal cord, and the section extended to paraglottic space, partial lateral wall of pyriform sinus, preepigottic space, superior-posterior of thyroid cartilage in those with restrained vocal cord motility. Supracricoid hemilaryngopharyngectomy and resection of medical wall and partial lateral wall of pyriform sinus were practiced in those with fixed hemilarynx. Cricoid ring and cervical esophagus were removed partially if the pyriform sinus apex was involved. 2. Reconstruction: Larynx: the remains of epiglottis, perichondrium of thyroid cartilage, the infrahyoid muscular fascia, and the platysmal flap were utilized to restore the defects of larynx. Pyriform sinus: Suturing the remaining pharyngeal mucosa directly to cover the wound if the defect was relatively small. For the large defect produced by extended resections, the pectoralis major myocutaneous flap and deltopectoral flap were used. 3. Surgical treatment of cervical lymphaden: Sixty five out of the 71 cases (91.5%) underwent neck dissection. Of which ipsilateral neck dissection were done in 39 cases, and bilateral neck dissection in 26 cases. 4. All patients received postoperative radiotherapy with doses of 60-75 Gy.

In the group of preservative surgery the 3- and 5-year survival rates were 63.4% and 49.6% respectively, whereas those in the total laryngectomy group were 52.4% and 42.4% respectively. Of the 49 cases with preservative surgery, 71.4% (35/49) had all laryngeal functions restored and 28.6% (14/49) partially restored.

Despite the fact that the medial wall pyriform sinus cancer tends to have laryngeal invasion, preservative surgery can be practiced for the majority of the cases with the lesions entirely removed.