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Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Primary and salvage (hypo)pharyngectomy: Analysis and outcome
Jonathan R Clark1, John de Almeida, Ralph Gilbert
1Department of Head and Neck Surgical Oncology, Princess Margaret Hospital, Wharton Head and Neck Centre, 610 University Avenue, Toronto, ON M5G 2M9.
Head & Neck
|May 25, 2006
Summary
Pharyngectomy for hypopharyngeal squamous cell carcinoma (SCC) offers viable outcomes for both primary and salvage surgeries. However, this high-risk procedure involves significant morbidity and survival challenges, particularly with advanced disease indicators.
Area of Science:
- Otolaryngology
- Surgical Oncology
- Head and Neck Cancer Research
Background:
- Pharyngectomy for hypopharyngeal squamous cell carcinoma (SCC) is typically reserved for advanced or salvage cases.
- Patients undergoing pharyngectomy face poor prognoses and significant perioperative morbidity.
Purpose of the Study:
- To evaluate disease-specific and treatment-related outcomes of primary and salvage pharyngectomies for hypopharyngeal and laryngeal cancer.
- To analyze outcomes over a 10-year period at a single tertiary referral center.
Main Methods:
- Retrospective review of 138 partial and circumferential pharyngectomies performed between 1992 and 2002.
- Analysis included patient demographics, follow-up duration, and treatment type (primary vs. salvage).
Main Results:
- Five-year overall survival rates were 38% for primary and 31% for salvage pharyngectomy.
- Disease-specific survival (DSS) at 5 years was 45% for primary and 40% for salvage.
- High morbidity rates (70%) and specific complications like hypocalcemia (44%) and fistulas (31%) were observed.
- Extracapsular spread (ECS) was the sole independent prognostic variable adversely affecting DSS on multivariable analysis.
Conclusions:
- Both primary and salvage pharyngectomy are feasible for advanced hypopharyngeal cancer, achieving high locoregional control.
- The procedure carries substantial operative risks and impacts survival.
- Patients with nodal metastases, ECS, and poorly differentiated tumors require careful consideration for adjuvant therapy due to poor prognosis.
