[Cancers of the hypopharynx. Course of surgical salvage]

Recovery surgery on irradiated hypopharyngeal zones, and the indications for this operation, have been transformed by currently available possibilities for pharyngeal reconstruction and protection of carotid axis by musculocutaneous pedicle flaps. Of 117 patients operated upon in the Curie Institute between 1960 and 1986 for hypopharyngeal cancer, after radiotherapy (mean dose 70 Gy), deglutition was restored in 100 cases (85%) after a mean healing period of 30 days. Fatal postoperative complications occurred in 23 patients (19%), including 12 carotid hemorrhages, but since 1980 the percentage of mortal bleeding has dropped from 15 to 5%. Postoperative survival was 50% at 1 year, 29% at 3 years and 15% at 5 years, results being similar whatever the indication (46 patients operated upon at end of radiotherapy, 36 local recurrences and 37 second cancers in irradiated zone). Local and regional recovery surgery was effective in only one patient out of two. The musculocutaneous flap allows wider and more certain surgery and improved functional results, but in no way affects the particularly serious nature of cancer of this localization.