LARYNGEAL PRESERVATION IN PATIENTS WITH A DVANCED CARCINOMAS OF THE POSTERIOR HYPOPHARYNGEAL WALL USING FREE-FLAP RECONSTRUCTION

In a series of 9 patients with advanced carcinomas of the posterior wa ll of the hypopharynx (2 patients with T2 tumors and 7 patients with T 4 disease), we tried to preserve the larynx with surgical therapy. The concept of laryngeal preservation consisted of lateral pharyngotomy w ith free flap reconstruction of the defect created by the tumor resect ion. A recommendation for surgery was given to each patient with a neo plasm in the posterior pharyngeal wall and tumor extension >6 cm in di ameter. The maximum tumor diameters ranged between 6.5 cm and 12.5 cm. Reconstruction was performed in 8 cases with radial forearm flaps whi le a jejunal transplant was used in one case due to the extension of t umor. During each surgical procedure an attempt was made to preserve t he superior laryngeal nerves and transplants were adapted exactly to t he resection defects. Seven patients achieved oral swallowing within t h ree months of surgery, while one patient needed four months to swall ow orally. One patient had persistent aspiration and still needs a per cutaneous gastrostomy. Six patients were decannulated successfully, so that laryngectomy was avoided during postoperative follow-up. These r esults show that surgical therapy of advanced carcinoma of the posteri or wa II of the hypopharynx is possible with preservation of the laryn x. Additionally, functional outcome after treatment of these patients with free flap reconstruction is comparable to other treatment modalit ies, such as radiochemotherapy.