Paraglottic space approach for hypopharyngeal surgery with laryngeal preservation: clinical experience and survival analysis

Hypopharyngeal carcinoma is a rare malignancy in China. The incidence is about 0.15/100000 in male and 0.02/100000 in female. However, taking account for the Chinses population base, it is not uncommon in the head and neck cancer center.

Surgical treatment of hypopharyngeal carcinoma with laryngeal preservation is still the most challenge in neck surgery. Precise incision of the mucosal tumor boundary is the key point and also difficulty for laryngeal preservation. So our team first use the paraglottic space approach to resect the hypopharyngeal carcinoma with preserve the laryngeal function in the world. The hypopharynx is an occlusive lumenal structure, so to facilitate the procedure, we need fully expose the tumor to give the surgeon a direct view.

Based on the experience of nearly 1500 cases, we improved a new paraglottic space approach for hypopharyngeal surgery with laryngeal preservation, which is highly indicative for T2-T3 piriform carcinoma. Then we entered the pharyngeal lumen near the arytenoid cartilage, and the tumor would be retraced laterally and a good surgical view with whole tumor could simplify the resection. Resection with this approach could preserve more normal mucosa, so reconstruction of laryngeal function would be more feasible. Among 213 cases of hypopharyngeal cancer in 2009 – 2011, the 5-year survival rates was 52.7%, compared the overall 5-year survival rates is 48.4%. The rate of fistula was controlled to 0.9%(2/213) and no sustained aspiration occurred.

Publication History

Publication Date:
18 April 2018 (online)