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Growth patterns of piriform sinus carcinomas
1Department of Otorhinolaryngology, Head and Neck Surgery, University of Bern, Inselspital, Switzerland.
The Laryngoscope
|April 1, 1997
Summary
Understanding piriform sinus carcinoma spread is key for voice preservation surgery. Lateral tumors may allow conservation surgery, while medial tumors often require extensive treatment due to laryngeal invasion.
Area of Science:
- Head and Neck Surgery
- Surgical Oncology
- Otolaryngology
Background:
- Functional surgery advances encourage organ preservation for piriform sinus carcinomas.
- Accurate histopathologic understanding is crucial for selecting voice preservation surgical candidates.
Purpose of the Study:
- To analyze tumor spread patterns in piriform sinus carcinomas.
- To define criteria for appropriate application of voice preservation surgery.
Main Methods:
- Whole-organ section study of 42 laryngopharyngectomy specimens.
- Analysis of tumor invasion into laryngeal and parapharyngeal structures.
Main Results:
- Carcinomas confined to the lateral wall rarely infiltrated intrinsic laryngeal muscles, suggesting conservation surgery feasibility, even for T4 cases.
- Medial wall or whole sinus tumors frequently infiltrated laryngeal structures (61% hemilarynx fixation) and spread contralaterally (64%).
- Isolated perineural or cricoarytenoid joint involvement was not observed.
Conclusions:
- Conservation surgery may be suitable for lateral piriform sinus carcinomas.
- Medial or extensive piriform sinus carcinomas often necessitate more radical surgical approaches due to significant laryngeal involvement and contralateral spread.