Conservation surgery for hypopharyngeal cancer: changing paradigm from open to endoscopic

Abstract

Conclusions: Endoscopic laser microsurgery (ELM) provides comparable oncological outcomes, and improved functional recovery and laryngeal preservation compared with open partial laryngopharyngectomy (OPLP) in patients with early squamous cell carcinoma of the hypopharynx (HPSCC). The use of open surgery is declining. The outcome of the study provides evidence-based recommendations for surgical choices in HPSCC treatment. However, it is not conclusive without a larger prospective study. Objectives: To compare the functional and oncological results of ELM and OPLP in HPSCC and examine surgical trends. Methods: From 1990 to 2008, 53 HPSCC patients undergoing ELM (n = 25) and OPLP (n = 28) were included. Functional recovery, oncological results, and laryngeal preservation rate were analyzed. Results: Patients who underwent ELM demonstrated a shorter decannulation period (7 vs 11 days, p = 0.010), time using a nasogastric tube (7 vs 16 days, p = 0.043), and hospitalization stay (12 vs 22 days, p = 0.0061) than those who underwent OPLP. The 3-year overall and disease-specific survival rates were comparable between ELM and OPLP (79% vs 64%, p = 0.151, and 83% vs 71%, p = 0.320, respectively). The ELM patients had better laryngeal preservation (92% vs 71%, p = 0.048). The number of OPLPs performed has decreased since 2000 (68% before vs 32% after, p < 0.0001).

Keywords::

• Carcinoma
• conservation surgery
• hypopharynx
• laser
• organ preservation

Acknowledgments

We thank the Biostatistics Task Force of Taipei Veterans General Hospital, Taipei, Taiwan, for statistical assistance. This study was sponsored by grants from the National Science Council (NSC 94-2314-B-075-066 and NSC 95-2314-B-075-062), Taipei, Taiwan.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.