Laryngorhinootologie

[Long-term functional outcome of Laccourreye hemipharyngectomy-hemilaryngectomy with reference to oncologic outcome]

Year 1998
Jacob R. Zorowka P. Welkoborsky HJ. Mann WJ.
Universitats-HNO-Klinik Mainz.
BACKGROUND: Various techniques for the treatment of hypopharyngeal malignancies are used to achieve disease control while preserving laryngeal function. PATIENTS AND METHODS: This study details the long-term results of 22 patients (ages 39-80; average age 57 years) following hemipharyngo-hemilaryngectomy (described by Laccourreye) for unilateral hypopharyngeal squamous cell carcinomas (G2-G3; T1-T4; N0-N3). Follow-up was 16-83 months (average 43) and included extensive speech and swallowing assessment. From 1989-1994 the procedure was performed in 26 patients. Two died within one year postoperatively, two were lost for follow-up, and 22 were included in this study. RESULTS: One patient developed recurrent disease with liver metastasis; two patients were successfully treated for recurrent disease. Two patients developed second primary tumors, while all others had no signs of recurrent disease. Fourteen patients had no difficulties eating or drinking. Six patients could only eat soft foods, and two patients required a gastrostomy feeding tube. Nineteen patients had a useful but hoarse voice, and three patients had severe difficulties when communicating. Modulation of voice was decreased because the supraglottic structures (mainly false cord and scar tissue) were used for phonation. Eighteen patients were completely satisfied with their voice. The tracheotomy was closed in 18 patients within six months, while four patients required a tracheostoma for more than two years. CONCLUSIONS: These data show that function-preserving surgical techniques can be successfully used in hypopharyngeal carcinomas even for patients with advanced disease. Useful functional results for swallowing, voice, and airway were achieved in most patients undergoing this procedure.