The modified Valsalva maneuver in hypopharynx CT scan / 临床耳鼻咽喉头颈外科杂志

Objective:To analyze the significance and factors influencing of CT scan under the modified Valsalva maneuver. Methods:Clinical data of 52 patients with hypopharyngeal carcinoma diagnosed from August 2021 to December 2022 were collected, all patients had calm breathing CT scan and modified Valsalva maneuver CT scan. Compare the exposure effect of the aryepiglottic fold, interarytenoid fold, postcricoid area, piriform fossa apex, posterior hypopharyngeal wall, and glottis with each CT scanning method. The effects of age, neck circumference, neck length, BMI, tumor site, and T stage on the exposure effect were analyzed. Results:In 52 patients, 50 patients（96.15%） completed CT scan at once time. The exposure effect of the CT scan under modified Valsalva maneuver in the aryepiglottic fold, interarytenoid fold, postcricoid area, piriform fossa apex, posterior hypopharyngeal wall was significantly better than CT scan under calm breathing（Z=-4.002, -8.026, -8.349, -7.781, -8.608, all P<0.01）, while CT scan under modified Valsalva maneuver was significantly worse in glottis than CT scan under calm breathing（Z=-3.625, P<0.01）. In the modified Valsalva CT scan, age had no obvious effect on the exposure effect. The exposure effect was better with long neck length, smaller neck circumference, smaller BMI and smaller T stage. The exposure of postcricoid carcinoma was better than pyriform sinus carcinoma and posterior hypopharyngeal wall carcinoma. But differences were not all statistically significant. Conclusion:The anatomical structure of the hypopharynx was clearly under CT scan with modified Valsalva maneuver, which clinical application is simple, but the effect of glottis was worse. The influence of age, neck circumference, neck length, BMI, and tumor T stage on the exposure effect still needs further investigation.

Carcinoma of the posterior wall of the hypopharynx: surgical treatment with larynx preservation / Carcinoma da parede posterior da hipofaringe: tratamento cirúrgico com preservação da laringe

Abstract Introduction: Posterior pharyngeal wall is the most rare subsite for hypopharyngeal carcinomas. Because of its rarity, there are few studies published in the literature specifically concerning posterior pharyngeal wall carcinoma. Objectives: To report our functional results in patients with the carcinoma of the posterior wall of the hypopharynx after surgical treatment by resection via a lateral or infrahyoid pharyngotomy approach, with the preservation of the larynx and reconstruction with a radial forearm free flap. Methods: The study included 10 patients who underwent surgery for a carcinoma of the posterior wall of the hypopharynx over a 6 year period. The associated postoperative morbidity was investigated and functional results were analyzed. Results: Nine patients had T3 lesions and one patient had a T2 lesion. The preferred approach to access the hypopharynx was a lateral pharyngotomy in 5 patients and lateral pharyngotomy combined with infrahyoid pharyngotomy in 5 patients with superior extension to oropharynx. The pharyngeal defects were reconstructed successfully with radial forearm free flaps. Four patients received adjuvant radiotherapy only, and 4 patients with N2b and N2c neck diseases received adjuvant chemoradiotherapy. The mean duration of hospitalization was 15.6 days (range, 10-21 days). All patients achieved oral intake in a median time of 74 days (range, 15-180). Decannulation was achieved in all patients and the median time fordecannulation was 90 (range, 21-300 days). The mean followup duration was 38.3 months (range, 10-71 months) and 8 patients survived. One patient died due to regional recurrence in the retropharyngeal lymph nodes and 1 patient died due to systemic metastasis. Conclusion: Primary surgery is still a very effective treatment modality for the carcinoma of the posterior wall of the hypopharynx and does not permanently compromise the swallowing and laryngeal functions if pharyngeal reconstruction is performed with a free flap.

Resumo Introdução: A parede posterior da faringe é o subsítio mais raro para carcinomas hipofaríngeos. Devido à sua raridade, há poucos estudos publicados na literatura especificamente sobre o carcinoma da parede posterior da faringe. Objetivo: Relatar nossos resultados funcionais em pacientes com carcinoma da parede posterior da hipofaringe após tratamento cirúrgico por ressecção via faringotomia lateral ou infra-hióidea, com preservação da laringe e reconstrução com retalho livre radial do antebraço. Método: O estudo incluiu 10 pacientes submetidos à cirurgia para carcinoma da parede posterior da hipofaringe por 6 anos. A morbidade pós-operatória associada foi investigada e os resultados funcionais foram analisados. Resultados: Nove pacientes apresentaram lesões T3 e um paciente apresentou lesão T2. Avia preferida para acessar a hipofaringe foi a faringotomia lateral em 5 pacientes e a faringotomia lateral combinada com a faringotomia infra-hióidea em 5 pacientes com extensão superior até a orofaringe. Os defeitos faríngeos foram reconstruídos com sucesso com retalhos livres radiais do antebraço. Quatro pacientes receberam apenas radioterapia adjuvante e 4 pacientes com doença cervical N2b e N2c receberam quimiorradioterapia adjuvante. A duração média da hospitalização foi de 15,6 dias (variação de 10 a 21 dias). Todos os pacientes retornaram à ingestão oral em um tempo médio de 74 dias (variação de 15 a 180). A decanulação foi possível para todos os pacientes e o tempo médio foi de 90 dias (variação de 21 a 300 dias). A duração média do seguimento foi de 38,3 meses (10 a 71 meses) e 8 pacientes sobreviveram. Um paciente foi a óbito devido a recorrência regional nos linfonodos retrofaríngeos e outro devido a metástase sistêmica. Conclusão: A cirurgia primária ainda é uma modalidade de tratamento muito eficaz para o carcinoma da parede posterior da hipofaringe e não compromete de forma permanente as funções de deglutição e da laringe se a reconstrução faríngea for feita com retalho livre.

Survival outcomes and prognostic factors of patients with salvage surgery for hypopharyngeal carcinoma after radiotherapy / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the survival outcomes and prognostic factors of patients with salvage surgery for hypopharyngeal carcinoma after radiotherapy. Methods: A retrospective analysis was performed, including 26 patients treated in Ningbo Medical Center Lihuili Hospital between January 2010 and December 2015. All patients were males, aged 48-83 years, of whom 8 cases were local residual after radiotherapy alone, 8 cases were local recurrence after postoperative radiotherapy, 2 cases were residual of cervical lymph nodes after radiotherapy alone, 2 cases were recurrence of cervical lymph nodes after radiotherapy alone, 2 cases were recurrence of cervical lymph nodes after postoperative radiotherapy and 4 cases were recurrence of tracheal stoma. The salvage operations included: local resection, local resection with neck dissection, simple neck dissection, tumor resection of tracheostomy, and additional repair according to the defect. Chi square test was used for recurrence and metastasis analysis, Kaplan-Meier method for survival analysis, Log-rank test for univariate analysis, and Cox regression model for multivariate analysis. Results: The complication rate of salvage surgery was 23.1% (6/26). The recurrence rate was 65.4% (17/26) and the distant metastasis rate was 42.3% (11/26) in the 5-year follow-up after salvage surgery. Patient's age and tumor invasion extent were correlated with recurrence. Initial treatment, tumor persistence or recurrence after radiotherapy, recurrence location and tumor invasion extent were correlated with distant metastasis (all P<0.05). Overall, 3 year and 5 year survival rates were 42.3% and 23.1% respectively. Age, recurrence location, surgical margin and tumor invasion extent were related to prognosis (χ²=6.56, 10.68, 9.32, and 7.90 respectively, all P<0.05). Multivariate analysis showed that surgical margin and tumor invasion extent were independent risk factors for prognosis (OR (95%CI) = 3.19 (1.03-9.84), 14.37 (2.46-84.08), both P<0.05). Conclusion: Salvage surgery is the first choice for patients with recurrence after radiotherapy for hypopharyngeal carcinoma. Safe surgical margin should be ensured, especially in tumors invading muscle, bone tissue or lymph node capsule.

Surgically-Treated Locoregionally Advanced Hypopharyngeal Cancer: Outcomes

Abstract Introduction Hypopharyngeal tumors are head and neck malignancies associated with a great mortality rate, and the treatment of advanced lesions constitutes a challenging problem. Pharyngolaryngectomy continues to be the gold standard treatment modality for locally-advanced diseases, and it is currently used as the primary treatment or in cases of relapse after an organ preservation strategy. Objective This study aims to compare the survival rates of patients with advanced hypopharyngeal tumors treated with pharyngolaryngectomy as a primary or salvage option, and identify possible prognostic factors. Methods All patients with advanced hypopharyngeal squamous cell carcinomas who performed pharyngolaryngectomy between 2007 and 2014 were reviewed retrospectively. Results A total of 87 patients fulfilled the aforementioned criteria, and the sample had a mean age of 57.2 years and a male predominance of 43:1. The tumors were located in the pyriform sinus walls (81 tumors), in the posterior pharyngeal wall (4 tumors) and in the postcricoid region (2 tumors). A total of 60 patients underwent surgery as the primary treatment option, and 27 were submitted to salvage pharyngolaryngectomy after a previous treatment with chemoradiotherapy or radiotherapy. The 5-year overall survival was of 25.9%, the 5-year disease-free survival was of 24.2%, and the disease-specific survival was of 29.5%. Conclusion The patients treated with pharyngolaryngectomy as the primary option revealed a better 5-year-disease free survival than the patients who underwent the salvage surgery (35.8% versus 11.7% respectively; p< 0.05). The histopathological criteria of capsular rupture of the lymph nodes (30.1% versus 19.8% respectively for the primary and salvage groups; p< 0.05) and vascular invasion (30.5% versus 22.5% respectively; p< 0.05) reduced the 5-year disease-free survival. Pharyngolaryngectomy as the primary intent revealed a lower local recurrence rate than the salvage surgery (40.6% versus 83.3% respectively; p< 0.05).

Cirugía transoral en hemangiomas de laringe e hipofaringe en adultos / Transoral surgery in laryngeal hemangiomas e hypopharynx in adults

Los hemangiomas son tumores benignos infrecuentes en la laringe. El tratamiento está indicado cuando el tumor produce síntomas (disnea, hemoptisis, odinofagia) y también cuando el riesgo de hemorragia severa por traumatismo es alto. Tres hemangiomas de laringe e hipofaringe fueron tratados con éxito por vía transoral con láser de C02 y radiofrecuencia. Todos los pacientes se alimentaron por vía oral a las 24/48 horas y ninguno tuvo traqueostomía. La tasa de resección completa de los hemangiomas tratados por vía transoral fue 100%. (AU)

Hemangiomas are a rare type of benign tumors of the larynx. The treatment is indicated when the tumor produces symptoms (dyspnea, hemoptysis, odynophagia) and also when the risk of severe bleeding from trauma is high. Three hemangiomas of the larynx and hypopharynx were successfully treated transorally with C02 laser and radiofrequency. All were orally fed at 24/48 hours, and none had a tracheostomy The complete resection rate of hemangiomas treated transorally was 100%. (AU)

Oncological results of surgical treatment versus organ-function preservation in larynx and hypopharynx câncer / Resultado oncológico de tratamento cirúrgico versus protocolo de preservação de órgão em câncer de laringe e hipofaringe

Summary Introduction: Since the beginning of the 1990s, non-surgical radiochemotherapy treatment has become popular with the prospect of maintaining oncological results and preserving the organ in patients with advanced squamous cell carcinoma of the larynx and hypopharynx. However, subsequent studies demonstrated increased recurrence and mortality after the non-surgical treatment became popular. Objective: To compare the oncological results of surgical and non-surgical treatments of patients with larynx and hypopharynx cancer and to evaluate the variables associated with disease recurrence. Method: This is a retrospective cohort study of 134 patients undergoing surgical (total or partial laryngectomy) or non-surgical (isolated radiotherapy, chemotherapy or induction chemotherapy followed by radiotherapy and chemotherapy) treatment, with 62 patients in the surgical group and 72 in the non-surgical group. Results: Disease-free survival rates were higher in the surgical group (81.7% vs. 62.2%; p=0.028), especially in III/IV stages (p=0.018), locally advanced tumors T3 and T4a (p=0.021) and N0/N1 cases (p=0.005). The presence of cervical lymph nodes, especially N2/N3, was considered a risk factor for disease recurrence in both groups (HR=11.82; 95CI 3.42-40.88; p<0.0001). Patients not undergoing surgical treatment were 3.8 times more likely to develop recurrence (HR=3.76; 95CI 1.27-11.14; p=0.039). Conclusion: Patients with larynx or hypopharynx cancer non-surgically treated had a poorer disease-free survival, especially in cases with locally advanced tumors (T3 and T4a) and in which the neck was only slightly affected (N0/N1).

Resumo Introdução: A partir de estudos do início dos anos 1990, popularizou-se o tratamento não cirúrgico com radioquimioterapia, com a perspectiva de manutenção do resultado oncológico e preservação do órgão em pacientes com carcinoma espinocelular avançado de laringe e hipofaringe. Entretanto, estudos posteriores demonstraram aumento da recorrência e da mortalidade com a difusão do tratamento não cirúrgico. Objetivo: Comparar o resultado oncológico dos tratamentos cirúrgico e não cirúrgico de pacientes com câncer de laringe e hipofaringe e avaliar as variáveis associadas à recidiva de doença. Método: Estudo de coorte retrospectiva de pacientes submetidos ao tratamento cirúrgico (laringectomia total ou parcial) e não cirúrgico (radioterapia isolada, radioterapia concomitante a quimioterapia ou quimioterapia de indução seguida de radioterapia e quimioterapia) de 134 pacientes, sendo 62 no grupo cirúrgico e 72 no não cirúrgico. Resultados: As taxas de sobrevivência livre de doença foram maiores no grupo cirúrgico (81,7% vs. 62,2%; p=0,028), principalmente em estádios III/IV (p=0,018), tumores localmente avançados T3 e T4a (p=0,021) e casos N0/N1 (p=0,005). A presença de linfonodos cervicais, principalmente N2/N3, foi considerada fator de risco para recidiva de doença nos dois grupos (HR=11,82; IC95% 3,42-40,88; p<0,0001). Pacientes não submetidos ao tratamento cirúrgico apresentaram 3,8 vezes mais chance de desenvolvimento de recidiva (HR=3,76; IC95% 1,27-11,14; p=0,017). Conclusão: Pacientes com câncer de laringe ou hipofaringe tratados de forma não cirúrgica tiveram menor sobrevivência livre de doença, especialmente nos tumores localmente avançados (T3 e T4a) e com pescoço pouco comprometido (N0/N1).

Thyroid gland invasion in advanced squamous cell carcinoma of the larynx and hypopharynx / Invasão da glândula tireoide no carcinoma espinocelular avançado de laringe e hipofaringe

Abstract Introduction: Squamous cell carcinoma of the larynx and hypopharynx has the potential to invade the thyroid gland. Despite this risk, the proposition of either partial or total thyroidectomy as part of the surgical treatment of all such cases remains controversial. Objectives: To evaluate the frequency of invasion of the thyroid gland in patients with advanced laryngeal or hypopharyngeal squamous cell carcinoma submitted to total laryngectomy or pharyngolaryngectomy and thyroidectomy; to determine whether clinic-pathological characteristics can predict glandular involvement. Methods: A retrospective case series with chart review, from January 1998 to July 2013, was undertaken in a tertiary care university medical center. An inception cohort of 83 patients with larynx/hypopharynx squamous cell carcinoma was considered. All patients had advanced stage disease (clinically T3-T4) and underwent total laryngectomy or total pharyngolaryngectomy in association with thyroidectomy. Adjuvant therapy was indicated when tumor or neck conditions required. Frequency of thyroid cartilage invasion was calculated; univariate and multivariate analysis of demographic, clinical and pathological characteristics associated with cartilage invasion were performed. Results: The overall frequency of invasion of the thyroid gland was 18.1%. Glandular involvement was associated with invasion of the following structures: anterior commissure (odds ratio = 5.13; 95% confidence interval 1.07-24.5), subglottis (odds ratio = 12.44; 95% confidence interval 1.55-100.00) and cricoid cartilage (odds ratio = 15.95; 95% confidence interval 4.23-60.11). Conclusions: Invasion of the thyroid gland is uncommon in the context of laryngopharyngeal squamous cell carcinoma. Clinical and pathological features such as invasion of the anterior commissure, subglottis and cricoid cartilage are more associated with glandular invasion.

Resumo Introdução O carcinoma espinocelular de laringe e hipofaringe tem potencial para invadir a glândula tireoide. Apesar desse risco, a proposição de tireoidectomia parcial ou total como parte do tratamento cirúrgico de todos esses casos permanece controversa. Objetivos Avaliar a frequência de invasão da glândula tireoide em pacientes com carcinoma espinocelular avançado de laringe ou hipofaringe submetidos a laringectomia total ou faringolaringectomia e tireoidectomia; determinar se características clínico‐patológicas podem prever o envolvimento glandular. Método Uma série de casos retrospectivos com revisão de prontuários, entre janeiro de 1998 e julho de 2013, foi feita em um centro médico universitário de cuidados terciários. Uma coorte inicial de 83 pacientes com carcinoma espinocelular de laringe/hipofaringe foi considerada. Todos os pacientes tinham doença em estágio avançado (clinicamente T3‐T4) e foram submetidos a laringectomia total ou faringolaringectomia em associação com tireoidectomia. Foi indicada terapia adjuvante quando o tumor ou as condições do pescoço exigiram. A frequência de invasão de cartilagem da tireoide foi calculada; análises univariada e multivariada das características demográficas, clínicas e patológicas associadas à invasão de cartilagem foram feitas. Resultados A frequência global de invasão da glândula tireoide foi de 18,1%. O envolvimento glandular foi associado à invasão das seguintes estruturas: comissura anterior (odds ratio = 5,13; intervalo de confiança 95%, 1,07‐24,5), subglote (odds ratio = 12,44; intervalo de confiança 95%, 1,55‐100,00) e cartilagem cricoide (odds ratio = 15,95; intervalo de confiança 95%, 4,23‐60,11). Conclusões A invasão da glândula tireoide é rara no contexto de carcinoma espinocelular laringofaríngeo. As características clínicas e patológicas, como a invasão da comissura anterior, subglote e cartilagem cricoide, estão mais associadas a invasão glandular.

Neo-adjuvant chemotherapy in advanced hypopharyngeal carcinoma.

Objective: The aim of this retrospective study was to find out the role of neo-adjuvant chemotherapy (NACT) in changing the management and outcome of advanced hypopharyngeal cancer patients. Materials and Methods: This is a retrospective analysis of 59 treatment naïve, advanced hypopharyngeal cancer patients presenting to our tertiary care center from April 2010 to October 2011. NACT was given as two (platinum with taxane) or three drug with (platinum, taxane with 5-flurouracil [5 FU]) as 3 weekly regimen with cisplatin and docetaxel as 75 mg/m 2 each, 5-FU as 1000 mg/m 2 . NACT was either given with the intent of achieving: (1) surgical resection (extensive soft tissue disease, oropharyngeal involvement, extensive disease with cartilage erosion) or (2) organ preservation (Bulky disease with inner cartilage erosion, exolaryngeal disease without cartilage erosion, large N3 nodes). Results: The mean age of this population was 55 years. Most (83%) of the patients had pyriform sinus (PFS) involvement. 69% patients had Stage IVa disease, 21% Stage IVb and 10% Stage III. The overall response rate was 66%, including 06% complete responses and 60% partial responses. Following NACT, resectability was achieved in 30% (10/33) and organ preservation protocol was planned after NACT in 73% (19/26) patients. The main toxicities were neutropenia (grade 3, 4, 04%; febrile neutropenia, 4%), mucositis 5%, diarrhea 5%. The median progression free survival was 20 months. Conclusions: NACT can be useful in patients with oropharyngeal involvement to achieve surgical resection and larynx preservation in patients with bulky T3 disease.

Early stage squamous cell carcinoma of the pyriform sinus: A review of treatment options.

The purpose of this review of the literature was to present treatment options for early stage pyriform sinus cancer. Squamous cell carcinoma of the pyriform sinus, as the most frequent cancer arising from the hypopharynx, is rarely diagnosed in its early stage. Based on evidence from retrospective studies, conservation surgery and definitive radiotherapy are considered the available treatment modalities for patients presenting with stage T1 and T2 pyriform sinus carcinomas without clinical evidence of neck lymph node metastases, offering similar results with respect to disease control and functional organ preservation. Also, the high risk of occult metastatic nodal disease even in the earliest stage of pyriform sinus cancer entails elective neck dissection or elective neck irradiation to be considered mandatory. However, for patients with early stage pyriform sinus cancer, no level 1 study exists in which conservation surgery is compared with radiotherapy alone for the evaluation of local control or survival. Randomized multicenter controlled trials evaluating efficacy of conservation surgery and definitive radiotherapy, and correctly interpreting functional outcome for each of the treatment procedures examined are necessary to obtain sufficient evidence to influence the decision in the choice of the most effective treatment for early pyriform sinus cancer.

Impacto da associação terapêutica na sobrevida livre de doença no câncer da hipofaringe / Impact of combination therapy on disease free survival in hypopharynx cancer

OBJETIVO: Avaliar a sobrevida livre de doença nos tumores de hipofaringe submetidos ao tratamento operatório e à radioterapia pós-operatória. MÉTODOS: Estudo retrospectivo de 174 pacientes com distribuição, de acordo com o estádio clínico em: dois casos de estádio clínico I; quatro II; 46 III e 122 IV. Quanto ao gênero, 163 eram masculinos e 11 femininos, com idade média de 56 anos. Todos os casos foram submetidos à faringolaringectomia e realizados 206 esvaziamentos cervicais radicais e 16 seletivos. Cento seis pacientes foram submetidos à radioterapia pós-operatória, com dose média de 58,2 Gy. RESULTADOS: O exame histológico demonstrou dois casos de estádio clínico pT1, 15 pT2, 100 pT3 e 57 pT4. Quanto aos linfonodos, 25 pacientes apresentavam ausência de linfonodos comprometidos pela neoplasia (pN0) e 149 com linfonodos comprometidos pela neoplasia (pN+). A sobrevida livre de doença há cinco anos foi de 40% e a global de 28%. A sobrevida livre de doença há cinco anos foi de 75% no estádio clínico III versus 28% no IV, de acordo com o resultado do exame histológico. CONCLUSÃO: A manifestação inicial do carcinoma epidermóide de hipofaringe ocorre na fase avançada (estádios III e IV), com sobrevida livre de doença a cinco anos superior no estádio clínico III.

OBJECTIVE: To evaluate the disease-free survival in hypopharyngeal tumors submitted to postoperative radiotherapy. METHODS: we retrospectively studied 174 patients with the following distribution: two cases of stage I, four stage II, 46 stage III and 122 stage IV. Regarding gender, 163 were male and 11 female; mean age was 56 years. All patients underwent pharyngolaryngectomy; neck dissections were radical in 206 and selective in 16. One hundred six patients underwent postoperative radiotherapy, with a mean dose of 58.2 Gy. RESULTS: Histological examination showed two cases of stage pT1, 15 stage pT2, 100 stage pT3 and 57 stage pT4. As for lymph nodes, 25 patients had no involvement (pN0); 149 presented with lymph node invasion (pN +). Five-year disease-free survival was 40% and the overall survival was 28%. According to the results of histological examination, five-year disease-free survival was 75% in clinical stage III versus 28% in IV. CONCLUSION: The initial manifestation of squamous cell carcinoma of the hypopharynx happens in advanced stages (III and IV), with superior five-year disease-free survival in clinical stage III.

Indication of elective contralateral neck dissection in squamous cell carcinoma of the hypopharynx / Indicação do esvaziamento eletivo contralateral no carcinoma espinocelular da hipofaringe

Lymph node metastases (LNM) are common in hypophariyngeal carcinomas; the neck dissection is an important therapeutic approach. AIM: to analyze the incidence and distribution of LNM and failures in treating the contralateral neck. METHODS: a retrospective study of 174 patients with hypopharyngeal cancer treated from 1978 to 2003. The distribution of LNM and regional recurrences were evaluated. RESULTS: 44 percent of the cases were false negatives and 4.9 percent were false positives. Among the 48 patients who underwent bilateral ND, 29 had bilateral metastases and one had contralateral metastasis. Contralateral neck recurrences occurred in 12 cases that underwent unilateral ND. Among the nine patients with contralateral neck recurrence alone, eight were surgically salvaged. The risk of contralateral metastases was related to clinical staging (p=0.003) and involvement of the medial wall of the pyriform sinus (p=0.03), but not to radiotherapy (p=0.28). CONCLUSION: Contralateral metastases were more frequent when the medial wall of the pyriform sinus was affected, in the presence of ipsilateral palpable metastases and clinical stage IV.

As metástases linfonodais são frequentes nos carcinomas da hipofaringe e o esvaziamento cervical é parte importante do tratamento. OBJETIVO: Avaliar a incidência e distribuição das metástases linfonodais e as falhas no tratamento do pescoço contralateral. MÉTODOS: Estudo retrospectivo de 174 pacientes com carcinoma epidermoide de hipofaringe tratados entre 1978 e 2003. Foi avaliada a distribuição das metástases linfonodais e as recidivas regionais. RESULTADOS: Foram diagnosticados 44 por cento de casos falso-negativos e 4,9 por cento falso-positivos. Dos 48 pacientes submetidos ao esvaziamento bilateral, 29 apresentaram metástases bilaterais e um apresentou metástase contralateral apenas. As recidivas cervicais contralaterais ocorreram em 12 casos submetidos ao esvaziamento unilateral. Dos 9 pacientes com recidiva cervical contralateral isolada, 8 pacientes foram resgatados cirurgicamente. O risco de metástases contralaterais relacionou-se com o estadiamento clínico (p=0,003) e com o comprometimento da parede medial do recesso piriforme (p=0,03), mas não com a realização de radioterapia (p=0,28). CONCLUSÕES: As metástases contralaterais nos carcinomas da hipofaringe foram mais frequentes quando a parede medial do recesso piriforme estava comprometida, na presença de metástases palpáveis ipsilaterais e estádio clínico IV.

Desarrollo histórico de las reconstrucciones faringoesofágicas después de una faringo-laringectomía total circular / Historical development of the pharyngoesophageal reconstructions after a total circular pharyngolaryngectomy

Se realizó una revisión bibliográfica sobre el desarrollo evolutivo de las diferentes técnicas quirúrgicas utilizadas para las reconstrucciones faringoesofágicas, después de la ablación de un cáncer faringolaríngeo. Este desarrollo evolutivo es abordado desde el punto de vista nacional e internacional, haciendo mayor énfasis en las técnicas más utilizadas actualmente.

A bibliographic review was made on the evolutive development of the different surgical techniques used for pharyngoesophageal reconstructions after the ablation of a pharyngolaryngeal cancer. This evolutive development was approached from the national and international point of view, making emphasis on the most used techniques nowadays.

Value of computed tomography for evaluating the subglottis in laryngeal and hypopharyngeal squamous cell carcinoma

CONTEXT AND OBJECTIVE: Subglottic involvement in squamous cell carcinoma is a determining factor for contraindicating conservative partial surgery. The subglottis is easily identified by axial computed tomography sections. The present study aimed to evaluate the occurrence of false-negative and false-positive results, and the overall accuracy of staging by computed tomography, in order to detect the involvement of the subglottic laryngeal compartment, in cases of laryngeal and hypopharyngeal squamous cell carcinoma. DESIGN AND SETTING: Retrospective, non-randomized study of patients treated at Hospital Heliópolis, São Paulo, Brazil. METHODS: Computed tomography scans were performed on third-generation equipment with 5-mm slice thickness. Afterwards, all patients underwent surgical and anatomopathological examinations as the gold standard procedures. RESULTS: Among 60 patients, 14 were diagnosed with subglottic extension by surgical and histopathological examination. There were three false-negative and no false-positive results from computed tomography scans. The sensitivity and negative predictive value were 100.0 percent. Accuracy was 95.0 percent, specificity was 93.5 percent and positive predictive value was 82.4 percent. CONCLUSIONS: Computed tomography could serve as a powerful auxiliary method for staging laryngeal and hypopharyngeal cancer. However, precautions should be taken in analyzing computed tomography scan data, because vegetating lesions may also be projected into the subglottic compartment, without real involvement of the subglottis, which may cause a false-positive result.

CONTEXTO E OBJETIVO: O envolvimento subglótico, em casos de carcinoma espinocelular, é fator determinante na contra-indicação da cirurgia parcial conservadora. A subglote pode ser facilmente identificada no cortes axiais da tomografia computadorizada. O presente estudo tem por objetivos avaliar a ocorrência de resultados falsos negativos, falsos positivos e a eficácia global do estadiamento por tomografia computadorizada na detecção do envolvimento do compartimento subglótico da laringe, em casos de carcinoma espinocelular de laringe e hipofaringe. TIPO DE ESTUDO E LOCAL: Retrospectivo não randomizado, realizado no Hospital Heliópolis, São Paulo, Brasil. MÉTODOS: Os exames de tomografia computadorizada foram realizados em equipamentos de terceira geração, com cortes com espessura de 5 mm. Todos os pacientes foram posteriormente submetidos a cirurgia com comprovação anatomopatológica, sendo este o padrão ouro. RESULTADOS: Dentre os 60 pacientes, o envolvimento subglótico ocorreu em 14, conforme observado no achado cirúrgico e ou anatomopatológico. A avaliação pela tomografia computadorizada resultou em três casos falsos positivos. Não ocorreram resultados falsos negativos. A tomografia computadorizada apresentou 100,0 por cento de sensibilidade, 100,0 por cento de valor preditivo negativo e 95,0 por cento de eficácia global. A especificidade foi de 93,5 por cento e o valor preditivo positivo de 82,4 por cento. CONCLUSÕES: Consideramos que a TC pode ser um poderoso instrumento auxiliar no estadiamento do câncer de laringe e de hipofaringe, devendo-se ter precaução com lesões vegetantes que se projetam para a subglote sem seu verdadeiro envolvimento.

Carcinoma sarcomatoide de hipofaringe: reporte de un caso / Sarcomatoid carcinoma of hypopharynx: report of a case

El carcinoma sarcomatoide es una rara neoplasia maligna de alto grado, la cual, ha sido motivo de controversias en su diagnóstico y su tratamiento. Se observa con frecuencia en el tracto aerodigestivo superior, aunque su localización en la hipofaringe es rara, habiéndose reportado pocos casos a nivel mundial. Se presenta una paciente femenina de 42 años sin historia de consumo de tabaco ni alcohol, quien presentaba disfagia, pérdida de peso, disfonía y masa cervical bilateral, mediante laringoscopia de fibra óptica se evidenció un extenso tumor de hipofaringe a nivel del seno piriforme izquierdo que invalida la laringe supraglótica. La histología del tumor reportó un carcinoma sarcomatoide. La paciente fue intervenida quirúrgicamente realizándose una laringofaringoesofagectomía con reconstrucción con ascenso gástrico más disección cervical radical bilateral, Presentó complicaciones pulmonares y abdominales, falleciendo a los 2 meses del posoperatorio. El carcinoma sarcomatoide es una rara y agresiva neoplasia cuyo pronóstico depende de su localización, tamaño y presencia de metástasis cervicales; aunque por lo general el pronóstico es malo independientemente del tratamiento recibido

Partial horizontal laryngectomy and epiglottiplasty / 华中科技大学学报（医学）（英德文版）

In order to evaluate the availability of the lateral horizontal laryngectomy and anaplasty of epiglottis to treat some patients with specific supraglottic carcinomas and hypopharyngeal carcinomas, 17 cases of laryngeal and hypopharyngeal carcinomas were retrospectively analyzed, whose tumors were located at the lateral margin of epiglottis, aryepiglottic fold, medial wall of piriform fossa and were treated by the lateral horizontal laryngectomy and anaplasty of epiglottis. The results showed that all cases took food by mouth in postoperative 9-14 days and subjected to decannulation in postoperative 9-15 days. Three cases had postoperative hoarse voice. The free-disease survival rate of 3 years was 71.4% in 14 cases followed up after the first surgical therapy, and the overall free-disease survival rate of 3 years was 85.7% after the second surgical therapy. It was concluded that the manipulations of the lateral horizontal laryngectomy and epiglottiplasty were simple. It could alleviate the postoperative symptoms of aspiration and bucking remarkably and shorten their postoperative recovery time, yet does not lower the survival rate of patients if laryngocarcinoma or hypopharyngeal carcinoma cases were properly selected.

Total hypopharyngeal reconstruction.

In advanced hypopharyngeal carcinoma, the tumor may involve the entire hypopharyngeal mucosa and the larynx. After total laryngohypopharyngectomy is done, reconstruction of the circumferential defect of the hypopharynx is a challenge. We described our results of using a myomucosal tongue flap with dermal or skin graft (MTF) in 8 patients and using a tubed pectoralis major myocutaneous flap (TPMF) in 10 patients to reconstruct the total hypopharynx. There was no operative mortality. Fistula formation occurred in 3 patients of the MTF group and 4 in the TPMF group but all had spontaneous healing after conservative treatment. One in the MTF group and 4 in the TPMF group had stenosis of the anastomotic sites. Almost all responded well with periodic dilatation. Only one patient in the TPMF group who had been previously irradiated required gastrostomy for feeding. The 5-year actuarial survival rate of our patients was 32 per cent. These results show that total hypopharynx can be reconstructed with the above noted procedures. The survival rate is good, the morbidity rate is acceptable, and the perioperative mortality rate is zero.

Reconstrucción faringoesofágica postresección laringofaringoesofágica total: resultados funcionales / Pharynx-esophagus reconstruction after total larynx-pharynx-esophagus resection: functional results

La reconstrucción de defectos funcionales del tracto digestivo superior debido a resecciones completas de laringe, asociada a hipofaringe y esófago cervical por cáncer primario de esta región es compleja y ha estado en constante cambio durante el presente siglo. Diversos métodos de reconstrucción han sido creados a objeto de restaurar el paso de los alimentos hacia el tracto digestivo distal a la lesión; estos métodos han ido desde el desarrollo de colgajo fasciocutáneos locales, colgajos miocutáneos pediculados a distancia hasta llegar a transposición de víscera libres. Desde 1985 hasta diciembre de 1999, se han recibido 435 casos portadores de cáncer de laringe, hipofaringe y esófago cervical, de éstos en 347 casos debió efectuarse algún tipo de cirugía como parte de su tratamiento quirúrgico; en 42 de estos casos la resección oncológica debió ser tan extensa que requirió de un proceso reconstructivo mayor del tubo digestivo: 20 casos se reconstruyeron con un tubo a partir de un colgajo miocutáneo pectoral mayor, 17 casos mediante un tubo de colgajo miocutáneo trapezial lateral, 4 casos mediante el trasplante de un segmento de yeyuno revascularizado y 1 caso mediante un ascenso gástrico. Se tuvo éxito en el logro de crear un buen pasaje alimenticio en 71,4 por ciento de los casos, con 60 por ciento para los casos con pectoral mayor, 82 por ciento para aquellos restaurados con colgajo trapezial y un 75 por ciento para aquellos en quienes se usó yeyuno libre. La mortalidad quirúrgica fue de un 7,1 por ciento para todo el grupo (3/42), siendo de un 15 por ciento para la técnica con colgajo pectoral mayor, 0 por ciento para los casos reconstruidos con trapezio, 0 por ciento para los casos reconstruidos con yeyuno

Reconstrucción faringoesofágica con el colgajo libre microvascularizado antebraquial. Reporte de dos casos / Pharyngoesophageal reconstruction with forearm microvascularized free flap

Se reportan dos casos de pacientes con carcinoma epidermoide de la hipofaringe tratados con faringolaringectomía total circular y reconstruidos con el colgajo libre antebraquial tipo chino tubulizado. El colgajo antebraquial es fácil de elevar, deja mínima morbilidad en el sitio donador, tiene un pedículo largo, es maleable y adaptable al sitio receptor y además evita la laparotomía necesaria para realizar la transposición colónica, el ascenso gástrico o el trasplante de yeyuno. Los casos aquí presentados no tuvieron complicaciones mayores postoperatorias y aunque cada caso presentó fuga de la anastomosis superior, ésta desapareció en un tiempo promedio de 10 días con tratamiento conservador, ninguno ameritó nueva cirugía ni reexploración de las anastomosis vasculares. El colgajo libre antebraquial tubulizado es una alternativa al ascenso gástrico, transposición colónica y colgajos pediculados en la reconstrucción de pacientes con cáncer de hipofaringe que requieren faringolaringectomía total circular, sus ventajas son: evitar la laparotomía, mantener la fisiología del tracto digestivo íntegra, menor morbilidad a otros procedimientos reconstructivos, morbilidad prácticamente nula en el sitio donador y requerir un solo tiempo quirúrgico