[Development of pharyngo-laryngeal surgery after radiotherapy]

Myo-cutaneous pedicled flap (MCF) had transformed technics and indications for salvage procedures after high doses of radiotherapy in laryngeal and hypopharyngeal carcinomas. Wide field total laryngectomies extended to oropharynx, skin, circular pharyngectomies extended to cervical oesophagus are possible with 3 times less carotid blow-up and rare fistulas. Radical neck dissection is currently performed in the same procedure without major healing problems. The feeding tube is often removed within a month. Systematic use of MCF in patients irradiated over 70 Gy may reduce the post-operative mortality and yield better survival rates, which at present 2 years after salvage surgery, are 36% in hypopharyngeal carcinomas (38/106) and 50% in laryngeal cancers (106/210).