Laryngohypopharyngoesophagectomy in advanced hypopharynxcarcinoma. Is there still a justification for this radical surgical treatment?

Minimal invasive laser surgery with preservation of the organs is well esta blished in the treatment of hypopharynx carcinoma. In cases of advanced tum ors of the hypopharynx, which can not be managed by laser surgery, the comb ined radio-chemo therapy becomes the treatment of choice because of the low morbidity and the comparable results. The indication for an operative proc edure, which means loss of larynx and oesophagus, is seen more and more res trictively. From 1993 to 1997 101 patients with advanced neoplasm of the hy popharynx or larynx (larynxcarcinoma T4; hypopharynx carcinomaT3-T4 with N > 2b) were treated in the Department of Otolaryngology of the University of Regensburg. 5 of these patients underwent a laryngohypopharyngoesophagecto my. Only patients with a severe dysfunction of the larynx (dyspnoe, dysphag ia, aspiration) were selected for this procedure. Postoperative complicatio ns were: one insufficiency of anastomosis with secondary bleeding and five pleura effusions. In all cases postoperative radiation began within six wee ks after the operation. All patients were nourished orally when they were d ischarged from hospital. The mean follow up was 21 months. During this time none of the patients died. In one case pulmonary metastasis was found afte r 11 months. In another case a regional recurrence was diagnosed after 11 m onths and was removed by operation. No local recurrence was found at that t ime. This operative procedure can be done only in experienced and well trai ned medical centers. Furthermore excellent cooperation of the operating tea ms and strong regard to the selection criteria is obligatory.