Evaluation of a new diagnostic modality for distal assessment of advanced, obstructing hypopharyngeal cancer

Pre-operative endoscopic assessment of the distal extension of hypopharyngeal cancer is essential for proper surgical extirpation. This assessment is frequently not feasible in advanced, obstructing tumours.

To study the role of a proposed new diagnostic technique: intra-operative open oesophagoscopy, in distal assessment of advanced hypopharyngeal cancer.

A clinicopathological study, including 35 consecutive patients with obstructing hypopharyngeal cancer.

Intra-operative open oesophagoscopy revealed inferior submucosal tumour extension in 19 out of 22 cases proven histopathologically, with a sensitivity, specificity and accuracy of 86, 100 and 91 per cent, respectively. Oesophageal skip lesions were detected in two cases. Intra-operative open oesophagoscopy findings surpassed data obtained from pre-operative radiological investigations and influenced the extent of resection performed. Accordingly, 19 patients had a total laryngopharyngectomy for local disease control, while 16 patients needed an additional total oesophagectomy. Histopathologically negative inferior resection margins were obtained in all cases.

Intra-operative open oesophagoscopy was found to be a reliable diagnostic modality for distal assessment of obstructing hypopharyngeal cancer in cases in which pre-operative distal endoscopic examination was not feasible.