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Surgical management of posterior pharyngeal wall carcinomas: Functional and oncologic results
Author(s) -
Julieron Morbize,
Kolb Frédéric,
Schwaab Guy,
Marandas Patrick,
Billard Valérie,
Lusinchi Antoine,
Le Ridant AnneMarie,
Luboinski Bernard
Publication year - 2001
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/1097-0347(200102)23:2<80::aid-hed1002>3.0.co;2-3
Subject(s) - medicine , surgery , radiation therapy , larynx , cancer , feeding tube
Background The optimal primary treatment for posterior pharyngeal wall tumors remains controversial. Methods To assess the relevance of surgical treatment from a functional and oncologic point of view, we reviewed the cases of 77 patients surgically treated between 1984 and 1995. Among them 23 had been previously irradiated. Fifty‐five patients underwent a conservative surgery (CS) sparing the larynx; 19 direct closures, 6 reconstructions of the posterior wall with a thoracic myocutaneous flap, 15 with a platysma flap, and 15 with a free forearm flap were performed. Twenty‐two patients underwent radical surgery (RS). All previously untreated patients had postoperative radiotherapy. The functional assessment concerned the CS group. Oncologic results, especially local control and survival were studied for the whole group. Results Of the 55 patients who underwent CS, 53 (96%) had their canula and 49 (89%) their feeding tube removed. At 1 year, in the platysma and free forearm groups, 21 of the 24 assessable patients were back to exclusive oral intake. For patients treated by primary surgery followed by radiotherapy, the rate of local failure was 11% (18% for tumors greater than 4 cm), and the 5‐year survival rate was 35%. For patients who had previous radiotherapy, the rates were, respectively, 52% and 16%. Conclusion The satisfactory functional results, caused by the improvement of reconstructive procedures, allow conservative surgery even in the case of large tumors. Oncologic results, especially local control, suggest that primary surgery followed by radiotherapy is effective for the treatment of posterior wall cancer. The oncologic results of surgery in a previously irradiated area are poor, and CS is not recommended in these cases. © 2001 John Wiley & Sons, Inc. Head Neck 23: 80–86, 2001.