Supracricoid hemilaryngopharyngectomy in selected pyriform sinus carcinoma staged as T2

Abstract

From 1964 to 1985 supracricoid hemilaryngopharyngectomy (SCHLP) was performed at the authors' institution for 34 selected pyriform sinus carcinomas staged as T2. Tumors involved the anterior part of the pyriform sinus, the lateral wall, the medial wall, and the whole aryepiglottic fold in all cases. Tumors with invasion of the apex of the pyriform sinus, of the retrocricoid region, of the posterior pharyngeal wall, or with fixation of the true vocal cord were excluded from the study. Such a technique was aimed at preserving physiologic phonation, respiration, and swallowing while achieving the same local control rate as pharyngolaryngectomy. Patients were monitored for at least 6 years or until death. No patients were lost to follow-up. The 5-year cause-specific survival rate was 55.8%. The main cause of death was second primary tumor. The 5-year actuarial local recurrence rate was 3.4%. The authors' experience with the SCHLP technique challenges the traditional teaching of pharyngolaryngectomy and establishes this technique as a safe method of voice preservation in selected cases of pyriform sinus carcinomas.

Supraglottic hemilaryngopharyngectomy plus radiation for the treatment of early lateral margin and pyriform sinus carcinoma

“…Our low local recurrence rate has also been noted by other authors like Laccourreye et al, [6][7] Ogura et al, 8 Vandenbrouck. 1 Our distant metastatic rate of 15% was high and similar to that noted by El Badawi et al 9 in a series of 71 hypopharyngeal tumors staged T1 or T2.…”

“…Pneumonia from aspiration was noted in 4% of cases in our series. When the ipsilateral vocal cord is resected, pneumonia from aspiration occurs more frequently; Laccourreye et al 6 reported a higher rate after supracricoid hemilaryngopharyngectomy.…”

Organ preservation with radiotherapy for T1‐T2 carcinoma of the pyriform sinus

“…Vandenbrouck et al 28 reported local control in 16 (89%) of 18 patients (UICC T1, 17 patients; T2, 1 patient) treated with conservation surgery at the Institut Gustave-Roussy. Laccourreye et al 30 reported on a series of 34 selected patients with T2 pyriform sinus carcinoma who underwent a supracricoid hemilaryngopharyngectomy at the Hôpital Laennec; patients had follow-up for Ն6 years. One patient had a local recurrence develop; the 5-year local control rate was 97%.…”

“…Vandenbrouck et al 28 observed that 2 of 18 patients undergoing a conservative operation required permanent tracheostomies. Laccourreye et al 30 observed no fatal postoperative complications in 34 patients treated with conservation surgery alone or combined with adjuvant RT or chemotherapy. Completion laryngectomy was performed in 2 patients (6%) because of persistent aspiration, and 1 patient died of chondronecrosis.…”

“…However, in some of the 23 patients who died of tumor recurrence (site unspecified), the disease was locally controlled; thus, the rate of local control with larynx preservation may be similar to that observed after RT. Laccourreye et al 30 reported laryngeal voice preservation in 32 of 34 patients who underwent a supracricoid hemilaryngopharyngectomy. The overall rate of local control with voice preservation in our series after RT alone was 83% (84 of 101 patients).…”