Medial vs lateral wall pyriform sinus carcinoma: implications for management of regional lymphatics.
BACKGROUND
Our purpose in performing this review is to analyze the relationship between the anatomic site of hypopharyngeal lesions and the pattern of recurrent disease, particularly cervical recurrence. This clinical information can subsequently be used to influence treatment options.


METHODS
The records of 169 patients with carcinoma of the hypopharynx treated between 1975 and 1986 were reviewed retrospectively. Patients were classified as having medial wall pyriform sinus disease (MP) lesions, lateral wall pyriform sinus (LP) lesions, posterior wall (PW), or postcricoid (PC) lesions. All patients were followed a minimum of 36 months. Patients with evidence of recurrent carcinoma were characterized according to the site of recurrence.


RESULTS
Recurrent carcinoma in the hypopharynx was noted in seven (4%) of 169 patients. Cervical metastases was the sole site of failure in 27 (16%) of 69 patients, whereas distant metastases developed in 25 (15%) of 169 patients. Failure in the contralateral unoperated neck occurred in 14% (10/71) of patients with MP lesions and, in contrast, 5% (4/76) LP patients. This difference was statistically significant (p = 0.04). Radiotherapy was not effective in preventing cervical recurrence in 20 (74%) of 27 overall neck failures and 11 (79%) of 14 contralateral NO neck failures.


CONCLUSIONS
These data suggest that patients with carcinoma involving the MP are at greater risk for contralateral cervical metastases. We recommend bilateral neck dissection be offered to patients with MP lesions.
Department of Otolaryngology, University of Pittsburgh School of Medicine, Pennsylvania.
J T
JT
Johnson
G W
GW
Bacon
E N
EN
Myers
R L
RL
Wagner
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D002423:Cause of Death; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000556:secondary*; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D010610:Pharyngeal Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate; D017211:Treatment Failure