Surgical Outcomes in Advanced Hypopharyngeal Cancer following Total Laryngopharyngoesophagectomy and Gastric Tube Reconstruction.

Jadunath, Buragohain (2009) Surgical Outcomes in Advanced Hypopharyngeal Cancer following Total Laryngopharyngoesophagectomy and Gastric Tube Reconstruction. Masters thesis, Cancer Institute (WIA), Chennai.


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INTRODUCTION : Hypopharyngeal carcinoma is associated with the highest mortality of all cancers of the head and neck. Poor survival rates are attributed to a preponderance of late presentations and to the unique behaviour of tumors occurring in this location. Tumors of this region typically remain silent until the disease has reached an advanced stage and causes symptoms from airway or digestive tract obstruction or pain from neural invasion. These are usually aggressive in behaviour, grow in an area of abundant lymphatic drainage, fail to produce early symptoms and signs and usually occur in people who are depleted nutritionally and immunologically compromised and hence treatment is difficult. Squamous cell carcinoma (SCC) accounts for 95% of hypopharyngeal pathology. It is one of the leading cause of cancer related morbidity and mortality in our country. Surgical ablation of advanced tumors of the hypopharyngeal and upper esophageal regions, together with optimal reconstruction of the resultant defect, has remained a surgical challenge. The goal of this surgery is a single stage reconstruction with low morbidity and mortality, short hospital stay, and early restoration of swallowing. AIMS AND OBJECTIVES : The aims of this study are to analyze following outcomes of patient with advanced hypopharyngeal cancers treated with Total Laryngopharyngoesophagectomy (TLPO) with gastric tube reconstruction. 1. Surgical outcomes, 2. Overall survival, 3. Prognostic factors influencing survival, 4. Recurrence patterns. MATERIALS AND METHODS : The study was conducted in Cancer Institute (WIA), Chennai. Case records of 122 patients out of 608 patients with histologically confirmed hypopharyngeal cancer were reviewed who underwent TLPO over 6 years period from 2001 to 2006. There were 69 males and 53 females. TLPO was carried out in 120 patients and total laryngopharyngectomy was done in two patients. 101 patients underwent neck dissection along with TLPO and gastric pull up was done in 120 patients and free jejunal flap reconstruction was done in one patients. One patient underwent total laryngopharyngectomy and control pharyngostoma and 97 patients received adjuvant radiotherapy. CONCLUSION : Surgical resection followed by adjuvant radiotherapy remains the standard of treatment for advanced hypopharyngeal carcinoma and gastric interposition is the preferred method of reconstruction for circumferential defect. In our study the mortality and morbidity rates were comparable with other studies. Prophylactic bilateral level II to IV nodal clearance should be considered for patients with N0 at presentation as there were no increase in morbidity by doing neck dissection and there was high percentage of occult nodal metastases in our study and specifically, the difference in long term survival is statistically significant among PN0 versus PN2 (P=0.03) in this subset of patient, where we can consider modification in adjuvant therapy. Overall survival in our study is comparable with other studies. In our study prognostic factors which influenced overall survival were: Pathological Stage (Stage II Vs Stage IVA, P=0.04), pathological T status (PT3 versus PT4, P=0.046), postoperative complications (P=0.0060) and adjuvant radiotherapy (P=0.008). Organ preservation strategies have not been as successful in hypopharyngeal cancers as for cancers of other head and neck sites. Further studies will be necessary to compare the use of chemoradiotherapy, larynx preservation, and surgery in terms of overall survival and quality of life, especially the ability to continue oral feeding.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Surgical Outcomes ; Advanced Hypopharyngeal Cancer ; Total Laryngopharyngoesophagectomy ; Gastric Tube Reconstruction.
Subjects: MEDICAL > Surgical Oncology
Depositing User: Kambaraman B
Date Deposited: 26 Jul 2017 02:37
Last Modified: 26 Jul 2017 02:37

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