Laryngo-Hypopharyngo-Ösophagektomie beimfortgeschrittenen Hypopharynxkarzinom - Ist dieser radikalchirurgische Eingriff heute noch gerechtfertigt? -

Abstract

Minimal invasive laser surgery with preservation of the organs is well established in the treatment of hypopharynx carcinoma. In cases of advanced tumors of the hypopharynx, which can not be managed by laser surgery, the combined radio-chemo therapy becomes the treatment of choice because of the low morbidity and the comparable results. The indication for an operative procedure, which means loss of larynx and oesophagus, is seen more and more restrictively. From 1993 to 1997 101 patients with advanced neoplasm of the hypopharynx or larynx (larynxcarcinoma T4; hypopharynx carcinoma T3-T4 with N > 2b) were treated in the Department of Otolaryngology of the University of Regensburg. 5 of these patients underwent a laryngohypopharyngoesophagectomy. Only patients with a severe dysfunction of the larynx (dyspnea, dysphagia, aspiration) were selected for this procedure. Postoperative complications were: one insufficiency of anastomosis with secondary bleeding and five pleura effusions. In all cases postoperative radiation began within six weeks after the operation. All patients were nourished orally when they were discharged from hospital. The mean follow up was 21 months. During this time none of the patients died. In one case pulmonary metastasis was found after 11 months. In another case a regional recurrence was diagnosed after 11 months and was removed by operation. No local recurrence was found at that time. This operative procedure can be done only in experienced and well trained medical centers. Furthermore excellent cooperation of the operating teams and strong regard to the selection criteria is obligatory.