SURGICAL-MANAGEMENT OF EARLY-STAGE HYPOPHARYNGEAL CARCINOMA

There is little consensus regarding the extent of surgical ablation th at is needed to attain cure in early-stage hypopharyngeal carcinoma (H PC). To determine effective surgical management of early-stage HPC, we retrospectively reviewed all cases of stage I or stage II HPC treated at our institution between 1970 and 1992. Of 305 patients identified with HPC, 50 (16%) had stage I (N = 13) or stage II (N = 37) cancer at diagnosis. Thirty-seven of the 50 (74%) underwent surgery alone or co mbined with preoperative or postoperative radiotherapy (RT). Patients were divided into three surgical groups. Group 1 underwent partial pha ryngectomy (N = 9), group 2 underwent total laryngectomy and partial p haryngectomy (N = 17), and group 3 underwent total laryngopharyngectom y with cervical esophagectomy and reconstruction (N = 11). Overall and disease-specific survivals were determined from Kaplan-Meier survival analysis. Disease-free 5-year survival in stage I and II HPCs was 40. 1%. Univariate analysis showed a statistically significant decrease in survival for patients undergoing partial pharyngectomy when compared with those undergoing more extensive procedures (p <.03). This was con firmed with multivariate loglogistic regression analysis (p <.03) corr ecting for confounding variables of site and RT. These data suggest th at wide resection improves disease-free survival in patients with earl y-stage HPC.