J.Jpn. Surg. Soc.. 102(9): 632-636, 2001
Feature topic
SURGICAL TREATMENT OF CARCINOMA OF THE HYPOPHARYNX AND CERVICAL ESOPHAGUS
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Division of Head and Neck Surgery, National Cancer Center Hospital, Kashiwa, Japan Satoshi Ebihara |
The standard surgical technique for the primary lesion is laryngo-pharyngo-esophagectomy in which the larynx is usually resected to prevent postoperative aspiration even if the cancer does not directly involve the larynx. Another common technique is total laryngectomy plus partial resection of the hypopharynx, where a very limited lesion in the unilateral pyriform sinus is resected with the surrounding hypopharyngeal mucosa and larynx. In this case, the defect in the hypopharyngeal mucosa is primarily sutured or reconstructed with a graft based on its size.
Experience has demonstrated that the larynx can be preserved without any postoperative aspiration if it is not involved by cancer and surgeons design the lines of resection and the postoperative shape of the reconstructed area to prevent aspiration. It has also been demonstrated that even if a part of the larynx is involved and must be resected, the remaining portion of the larynx can sometimes be preserved without any distinct aspiration.
There are two common surgical techniques for neck lymph nodes. Radical neck dissection is the classic one, in which the lymphatic tissues together with the surrounding structures, including the sternocleidomastoid muscle, internal jugular vein, and accessory nerve are resected. Conservative neck dissection resects the lymphatic tissues only and preserves other structures. Currently, the standard surgical technique is conservative neck dissection. Radical neck dissection is rarely performed now because its morbidity is much higher and its superiority in treatment results has not been established.
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