Clinicopathological factors influencing the outcomes of surgical treatment in patients with T4a hypopharyngeal cancer

Abstract

BackgroundThe purpose of this study was to determine prognostic factors influencing outcomes of surgical treatment in patients with T4a hypopharyngeal cancer.MethodsThe present study enrolled 93 patients diagnosed with T4a hypopharyngeal cancer who underwent primary surgery between January 2005 and December 2015 at six medical centers in Korea. Primary tumor sites included pyriform sinus in 71 patients, posterior pharyngeal wall in 14 patients, and postcricoid region in 8 patients. Seventy-two patients received postoperative radio(chemo)therapy.ResultsFive-year disease-free survival (DFS) and disease-specific survival (DSS) rates were 38% and 45%, respectively. In univariate analysis, 5-year DFS was found to have significant and positive correlations with margin involvement (p < 0.001) and extracapsular spread (p = 0.025). Multivariate analysis confirmed that margin involvement (hazard ratio (HR): 2.81; 95% confidence interval (CI): 1.49-5.30; p = 0.001) and extracapsular spread (HR: 2.08; 95% CI: 1.08-3.99; p = 0.028) were significant factors associated with 5-year DFS. In univariate analysis, cervical lymph node metastasis (p = 0.048), lymphovascular invasion (p = 0.041), extracapsular spread (p = 0.015), and esophageal invasion (p = 0.033) were significant factors associated with 5-year DSS. In multivariate analysis, extracapsular spread (HR: 2.98; 95% CI: 1.39-6.42; p = 0.005) and esophageal invasion (HR: 2.87; 95% CI: 1.38-5.98; p = 0.005) remained significant factors associated with 5-year DSS.ConclusionMargin involvement and extracapsular spread are factors influencing recurrence while extracapsular spread and esophageal invasion are factors affecting survival in patients with T4a hypopharyngeal cancer treated by primary surgery.

Primary pharyngolaryngectomy with jejunal free flap reconstruction: a single centre's evolving experience

“…11 The disease-specific survival in the patient population was comparable, if not better than that in the current literature (44-49%). 6,[10][11][12] Interestingly, 5-year overall survival was on the lower limits of that previously published (26.9-49%). 10,12,13 One potential confounder in this data is that all patients presented with stage III or IV disease (96.7% ≥T3 primary, 87.6% ≥N1), higher than that of other published populations (70-85% stage III or IV).…”

“…In keeping with published trends, the majority of patients were male and aged in their 60s. 6,7 The number of patients presenting with late disease (stage III or IV, AJCC Seventh Edition criteria) was 100%, notably higher than that quoted in other published studies which range from 70% to 85%. 2,8 Prior data from the same unit at Princess Alexandra Hospital a decade earlier found only 67.8% of patients presented with stage III or IV disease.…”

“…A larger sample size would be needed to further investigate this; however, similar studies also suggest these as predictors of recurrence and/or poor survival, with the addition of male gender, perineural invasion, oesophageal invasion and poor performance scores. 6,14 Free flap reconstructive techniques have long been associated with prolonged hospital admissions and increased risk of postoperative complications in comparison to primary closure procedures. The median length of hospital stay for this study was 18 days (mean 24.6 days, 11-77 days), similar to that previously published for TPL with JFF reconstruction (16-23 days).…”

Morphological analysis of ischemia-reperfusion injury in a cold ischemia model of jejunal free flap for hypopharyngeal reconstruction

“…The majority of these cancers present with bulky neck nodes and extensive submucosal disease. 1 The available therapeutic options are surgery followed by adjuvant treatment or organ preservation in the form of chemoradiation therapy. Although primary treatment of hypopharyngeal cancer is increasingly relying on nonsurgical modalities, for selected advanced stages and for patients in whom nonsurgical treatment fails, surgery remains the only curative option.…”

“…Although primary treatment of hypopharyngeal cancer is increasingly relying on nonsurgical modalities, for selected advanced stages and for patients in whom nonsurgical treatment fails, surgery remains the only curative option. 1,2 Surgical treatment of advanced hypopharyngeal cancer remains a challenge because of the difficulty of restoring digestive continuity, considering the distance covered, and the provision and maintenance of adequate blood supply to the reconstruction grafts, and ultimately, it depends on the amount of pharyngeal resection required. In some patients, the pharyngeal wound can be primarily closed, but extensive partial or circumferential pharyngeal resections require reconstruction to close the defect.…”