Predictors of Thyroid Gland Involvement in Hypopharyngeal Squamous Cell Carcinoma

PURPOSE: Decision to perform concurrent ipsilateral thyroidectomy on patients with hypopharyngeal cancer is important, and unnecessary thyroidectomy should be avoided if oncologically feasible. We hypothesized that concurrent ipsilateral thyroidectomy is not routinely required to prevent occult metastasis. This study aimed to determine the prevalence of histological thyroid invasion in patients with hypopharyngeal cancer, and to refine the indications for prophylactic ipsilateral thyroidectomy in patients with hypopharyngeal cancer. MATERIALS AND METHODS: A retrospective review of the medical records from the Department of Otolaryngology at Yonsei University College of Medicine was conducted from January 1994 to December 2009. A total of 49 patients underwent laryngopharyngectomy with thyroidectomy as a primary treatment of hypopharyngeal cancer. RESULTS: The incidence of thyroid gland involvement was 10.2%. The most common route of invasion was direct extension through the thyroid cartilage. Thyroid cartilage invasion (p=0.034) was the most significant factor associated with thyroid invasion. Disease-specific survival at 5 years was lower in patients with than without thyroid gland invasion (26.7% vs. 55.2%, respectively; p=0.032). Disease-free survival at 5 years was also lower in patients with than without thyroid gland invasion (20.0% vs. 52.1%, respectively; p=0.024). CONCLUSION: Ipsilateral thyroidectomy in combination with total laryngopharyngectomy is indicated when invasion of the thyroid cartilage is suspected in patients with hypopharyngeal cancer.

[Usage of direct laryngoscopy in patients with laryngopharyngeal lesions]

Endoscopy of laryngopharyngeal diseases by direct laryngoscopy [DL] is still a valuable and useful endoscopic method for diagnosis, treatment and following them up. In this study, the safety of DL as an outpatient procedure is associated. This prospective study was performed on 146 patients who needed an endoscopic evaluation based on primary clinical diagnosis during two years in ENT ward of Ghaem hospital. While DL, macroscopic evaluation and biopsy was done and patient's tolerance during DL with local anesthesia, complications, age and sex, chief complaint, primary clinical findings and the results of endoscopy and pathology was written in a questionnaire and then analyzed. In 146 patients, laryngoscopy was done with local anesthesia in 84% and as an outpatient procedure in 75% and complications resulting to admission were not seen .Age average was 55 +/- 14, male to female ratio 2 to 1, the most common decade 6 and 7, and the most common complaint was dysphonia. Also, 51% of lesions were neoplastic that the squamous cell carcinoma was the most common. 21% of squamous cell carcinomas were seen in hypopharynx and 78% in the larynx. In the larynx, supraglottis was the most common site [69%] while the glottis and infraglottis were the next sites [18% and 6% respectively]. Male to female ratio of laryngeal and hypopharyngeal carcinoma was 5.3 to 1 and 3 to 4 consequtively. Much less incidence of benign neoplasm in our patients compared with other populations and older age in average, are seen in our results. Also, much more involvement of supraglottis compared with the glottis of the larynx, and male to female ratio of 3 to 4 in hypopharyngeal carcinoma of our patients are of other main differences seen in this study. Similar studies using the newer techniques and equipments such as videolaryngoscopy are needed to confirm the accuracy and safety of them compared with DL in the future

Reconstrucción de hipofaringe y esófago cervical con colgajos miocutaneos / Miocutaneous flaps for hypopharynx and cervical esophagus reconstruction

Se presenta una serie de 16 reconstrucciones de hipofaringe y esófago cervical con colgajos miocutáneos. Se usaron 12 colgajos tropicales y 4 pectorales. Se analizan las características de los carcinomas esofágicos altos y se comentan los resultados de esta cirugía.