Abstract. Stage IV circular hypopharyngeai cancer is a disease with poor long-term survival, and the only means of cure---surgery~is associated with high morbidity. All patients admitted with circular hypopharyngeal cancer and extension to the esophagus were enrolled in a multidisciplinary treatment protocol, including circular laryngopharyngoesophagectomy with tracheostomy, neck dissection, and pull-up of a fundus rotation gastric tube that was anastomosed to the oropharynx. Five weeks postoperatively high-dose radiotherapy (60 Gy) was given to the cervical region. Altogether, 18 qualifying patients were explored cervically, were found to have resectable lesions (i.e., without carotid artery infiltration), and were included in the protocol. After laryngopharyngoesophagectomy, an elongated gastric tube was pulled up to the oropharynx. The average distance bridged with the tube was 32 ---4 cm. No anastomotic leaks were found on postoperative Gastrografin swallow, and oral feeding was started between days 5 and 8. Patients were discharged with normal oral feeding on day 21 ( -17 days). Diarrhea, postprandial fullness, and reflux resolved within 6 months postoperatively. Five patients died during the follow-up period of 42 months (range 3-63 months): three due to cardiac events 18 and 38 months postoperatively and two within 12 months with residual disease and tumor recurrence, respectively. The estimated 5-year survival was 60%. We concluded that an aggressive multidisciplinary approach including circular laryngopharyngoesophagectomy, neck dissection, and high-dose radiotherapy ascertains good long-term survival and good functional results in patients with advanced hypopharyngeai cancer when the intestinal continuity is reconstructed with a fundus rotation gastroplasty.The dismal outcome of advanced-stage hypopharyngeal cancer is determined by tumor biologic factors and late patient presentation [1,2] as well as by inconsistent treatment strategies [3][4][5][6]. Although oncologic aspects require a circular laryngopharyngectomy [7] and postoperative irradiation [4,8], the short life expectancy of these patients mandates the acknowledgment of palliative aspects such as their swallowing capability and overall quality of life. The difficult reconstructive procedure after circular laryngopharyngoesophagectomy has been approached with a total gastric pull-up by Ong and Lee [9]. Their procedure, however, was not favored by many Western surgeons owing to the high anastomotic