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A Journal on Otorhinolaryngology, Head and Neck Surgery,
Plastic Reconstructive Surgery, Otoneurosurgery
Indexed/Abstracted in: EMBASE, Scopus
Otorinolaringologia 2005 June;55(2):133-46
Malignant tumours of the hypopharynx: state of the art
Bussi M., Carlevato M. T., Fabiano B., Maj G., Giordano L.
Divisione ORL, hSR Università degli Studi Vita–Salute San Raffaele, Milano
The treatment of hypopharyngeal tumours remains controversial because, in spite of the unquestionable therapeutic advances that have been made, prognosis continues to be severe and operations often highly demolitional and invalidating with overall survival of only 40% at 5 years. The main feature of these tumours is their submucous spread; satellite tumours are therefore frequent in this area and this fact lies at the basis of the need for demolition operations and the frequent therapeutic failures. The search for new molecular markers is necessary in tumours with unfavourable prognosis such as hypopharyngeal carcinoma in which the lack of clinical signs and symptoms in the early stage of the disease conditions the late diagnosis. The CT is presently the X-ray investigation of choice (because it permits staging and the search for an invasion of the cartilage and the pre-epiglottic space), possibly integrated with NMR investigation and echography. The role of panendoscopy as a routine method for evaluating patients with head and neck tumours remains controversal considering its intrinsic morbility and cost; the high incidence of double tumours in case of neoplasias of the pyriform sinus fully justifies their routine use in our opinion. A review of the international series suggests that the incidence of occult metastases in clinically N0 tumours of the piriform sinus is about 58%. The elective indication for neck dissection should therefore be unquestioned also in cases whose clinical stage is N0. The possible involvement of the hypopharyngo-oesophagus or the clear oesophgeal extension imply the need for demolition operations with consequent reconstructive procedures that are on the one hand indispensable but often problematic in patients generally characterised by low performance status, as carriers of hypopharyngeal tumours often are. In consideration of the unfavourable prognosis and the type of patients concerned, it is worth planning reconstruction on the basis of the fastest and safest options up to the most complex. Hypopharyngeal tumours often present an extension in the submucosa that only comes to light during the operation; hence the possibility of a circular reconstruction must always be considered and suggested to patients pre-operatively. In addition, in recent years, the refinement of radiation techniques and chemotherapeutic treatments has made organ conservation protocols ever more promising. In their turn, these conservation protocols can make use of possibilities for surgical recovery thanks to reconstructive techniques that are more and more advanced and safe. The high relapse rate (overall 50% within 2 years) of hypopharyngeal tumours, however they are treated, makes a very scrupulous follow-up necessary.