Surgical treatment of hypopharyngeal tumours

A review of 51 patients who underwent total pharyngolaryngectomy between 1972 and 1989 was undertaken and factors influencing hospital mortality and long-term survival were examined. All patients had advanced hypopharyngeal or cervical oesophageal cancer, and alimentary continuity was restored with either subcutaneous colon (39 patients) or stomach (12 patients). The overall hospital mortality rate was 25% (13 patients). Mortality was mainly caused by cardiac problems or sepsis. The 1-year survival rate was 36% and two of 26 patients (8%) survived more than 5 years. Survival was better when gastric transposition was used for reconstruction (P = 0.01). Other significant factors affecting survival were operative year, presence of metastatic cervical lymphadenopathy and microscopic pharyngeal penetration. It is concluded that surgical ablation is a viable option for advanced hypopharyngeal and cervical oesophageal neoplasia, with stomach interposition the preferred method of reconstruction. Although the prognosis is poor, satisfactory short-term palliation can be achieved.