[Surgical management of elderly patients with medial wall pyriform sinus cancer]

Objective: To investigate the clinical efficacy of preoperative-, postoperative-radiotherapy and surgery for preserving laryngeal function in patient over 70 years of age with medial wall pyriform sinus cancer. Methods: Clinical data of 48 patients over 70 years of age with medial wall pyriform sinus cancer who received surgical treatment from January 2001 to December 2010 were retrospectively analyzed. Among them, 21 cases were given preoperative radiotherapy and surgery (R+ S). The radiation therapy dose was 45 Gy. And 14 cases' larynx is preserved. In addition, 27 cases were given postoperative radiotherapy and surgery (S+ R). The radiation therapy dose was 65 Gy. And 10 cases had preserved laryngeal function. Survival rates were analyzed by the Kaplan-Meier method. Chi-square test was used to compare complications between two groups. Results: The larynx preservation rate in R+ S group [66.7% (14/21)] was significantly higher than that in S+ R group [37.0% (10/27), P<0.05]. The complication rate and decannulation rate in R+ S group were 42.9% (9/21) and 64.3% (9/14), respectively, showing no difference compared with those in S+ R group [37.0% (10/27) and 50.0% (5/10), respectively] (all P>0.05). The complication rates of patients with and without larynx preservation were 41.7% (10/24) and 37.5% (9/24), respectively, showing no difference between two groups (P>0.05). The overall 3-years and 5-years survival rates for all patients were 54.2% (26/48) and 35.4% (17/48), respectively. There was no significant difference in survival rates between R+ S [38.1% (8/21)] group and S+ R group [33.3% (9/27), P>0.05)]. In the R+ S group, the survival rates in patients with and without larynx preservation were 40.0% (4/10) and 29.4% (5/17), respectively, showing no significant difference between two groups (P>0.05). Conclusions: It is secure and effective to choose the operation with laryngeal preservation for patient over 70 years of age with medial wall pyriform sinus cancer based on their physical conditions and the tumor extension. The preoperative- and postoperative-radiotherapy have the similar effect. Preoperative radiotherapy and surgery increases the laryngeal preservation rate.