A classification system for the reconstruction of vertical hemipharyngolaryngectomy for hypopharyngeal squamous cell carcinoma.
OBJECTIVE
To evaluate microvascular reconstruction of a vertical hemipharyngolaryngectomy (VHPL) defect for hypopharyngeal squamous cell carcinoma.


METHODS
Retrospective analysis of medical records.


METHODS
Tertiary care referral center.


METHODS
Thirty-two patients who underwent a VHPL.


METHODS
Assess the surgical technique and safety of VHPL and review the functional parameters of swallowing and decannulation.


RESULTS
The classification was composed of 3 types of VHPL according to the extent of resection: limited VHPL (type I), resection at the lateral border of the conus elasticus to preserve both vocal cords (n = 10); total VHPL (type II), removal of a vertical section of the thyroid cartilage through the anterior commissure to the upper border of the cricoid cartilage with preservation of 1 vocal cord (n = 12); and extended VHPL (type III), inclusion of a supraglottic laryngectomy (type IIIa) (n = 6) or partial cricoid cartilage resection (type IIIb) (n = 4). A radial forearm free flap that included the palmaris longus tendon was used for reconstruction in 31 patients, and an anterolateral thigh flap was used in 1 patient. There was no perioperative mortality, and there was 100% free flap survival. Oral realimentation and tracheotomy weaning were achieved a mean of 33 and 32 days postoperatively, respectively. In 25 patients observed for longer than 6 months, the recurrence rate was 28% (7 of 25), and 5-year disease-specific survival was 64%.


CONCLUSIONS
Microvascular reconstruction of VHPL offers a wider resection with promising functional results for hypopharyngeal carcinoma.
Department of Otolaryngology-Head and Neck Surgery, The Catholic University of Korea, Seoul. entkms@catholic.ac.kr
Min-Sik
MS
Kim
Young-Hoon
YH
Joo
Kwang-Jae
KJ
Cho
Jun-Ook
JO
Park
Dong-Il
DI
Sun
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply*; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D007013:Hypopharynx / Q000473:pathology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D007723:Korea; D007825:Laryngectomy / Q000379:methods*; D008297:Male; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000145:classification* / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome