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.

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).

Otolaryngologic manifestations of gastroesophageal reflux disease

To determine frequency of endoscopic oesophagitis in the patients who complain the chronic laryngopharyngeal disorders in the absence of typical gastroesophageal Reflux Disease [GERD] symptoms. Descriptive study The study was carried out in the department of E.N.T at Nawabshah Medical Centre, Nawabshah over the period of two years [2004 to 2006]. One hundred patients of either sex and in the age group between 25-79 years with symptoms of chronic laryngopharyngeal disorders were selected for study. All patients had physical examination of upper aero digestive tract. Direct laryngoscopy was done to evaluate the status of larynx, however rigid esophagoscopy was done to evaluate the status of esophageal mucosa and biopsies from lower part of esophagus were taken in all patients. Eighty percent of patients with symptoms of chronic laryrigopharyngitis were also suffering from microscopic Oesophagitis. Among the 80% patients 87.5% were having non-erosive oesophagitis while 12.5% were having erosive oesophagitis. In significant number of patients with chronic upper respiratory symptoms resistant to the treatment, there was co existing gastroesophageal disease which could be the cause of the symptoms

[Hypopharyngeal Zenker's diverticulum about four cases]

The hypopharyngeal Zenker's diverticulum is a rare pathology [1%of oesophagien pathology]. It is up to a hernia of the oesophagus posterior wall throught the fibres of the pharynx inferior constrictor muscle. Many pathogenic hypotheses are put forword; it is generally benign but can cause serious complications. The treatment can be difficult. The best treatment seems to be diverticulectomy with cricopharyngeal myotomy. Endoscopic treatment can be a good therapeutic alternative. We report four cases of patients with DPO three women and one man; the mean age of patients was 67 years. All our patients suffered from dysphagia and loss of weight. The diagnostic, clinically suspected was cofirmed by radiological examinations. All our patients were operated. Surgery was satisfactory for three patients. One patient died

[ correlation between helicobacter pylori infection and squamous cell carcinoma of larynx and hypopharynx]

From the most important laryngeal and hypopharyngeal cancer risk factors are smoking, alcohol and anemia. But reflux is one of the suggested etiologies. Pregnancy, Nonstroidal anti inflammation drugs and drugs decreasing the lower esophageal sphincter pressure will increase the reflux. Helicobacter pylories role in reflux formation is different due to the involved region and can also have a decreasing role and decline the rate of a series of esophageal and upper aero digestive system disease. This cross - sectional and case - control study was done in Qaem medical hospital, Mashhad during the years 1384 and 1385, for serum level detection of anti -H.pylori IgG and IgA antibodies in blood samples of both control and case groups. The variables were age, sex and serum test results. 45 patients [39 male and 6 female] and 42 controls [33 male and 9 female] were evaluated. 2 groups were matched for age and sex. Positive IgG and IgA results in patients in order was 3 person [6.6 percent] and 3 person [6.6 person] and in control group 26 person [61.9%] and 12 person [28.5%]. Result [P>0.001] was for healthy group showing the protective effect of H. Pylori against laryngeal cancer. In our study, control group with a meaningful difference was affected by H.Pylori infection. This can be due to a protective effect for H. Pylori against the laryngeal and hypopharyngeal malignancies. Prospective studies and simultaneously evaluation of reflux, H. Pylori infection and the regain of gastric location are suggested

A case of pleomorphic lipoma of the hypopharynx

Se describe aquí el primer caso de un lipoma pleomórfico de la faringe en un hombre de 69 años quien acudió por disfagia y tos de 12 años de evolución. En la laringo-faringoscopía se observó una neoplasia submucosa de color amarillo, polipoide y de límites bien definidos. En la tomografía era hipodensa y midió 3 cm. Histológicamente estuvo compuesta por tejido adiposo maduro, bandas de tejido conectivo y células gigantes pleomórficas, algunas con aspecto en roseta. No se observaron lipoblastos ni mitosis. Seis meses después de la resección no hubo evidencia de recurrencia