Significance of preserving the parathyroid glands in total pharyngo-laryngectomy

Hypoparathyroidism after total pharyngo-laryngectomy sometimes induces severe complications. It is often quite difficult to control the calcium metabolism. So it is crucial to preserve the function of the parathyroid glands. It is also significant economically, as we must focus on the preservation of parathyroid glands during the surgical management of hypopharyngeal cancer. From 1999 to 2005, 63 patients with hypopharyngeal squamous cell carcinoma underwent total pharyngo-laryngectomy and bilateral neck dissection with reconstruction using the free jejunum flap. Among them, 52 were male and 11 were female. The mean and standard deviation of age of these patients were 63.2 and 7.7. Forty-seven of these cases had PS cancers, 7 had PC cancers and 9 had PW cancers. We usually preserved the parathyroid glands attached to the thyroid gland by preserving only the superior vessels of the thyroid gland. Inferior vessels were resected for wide exposure of the paratracheal and paraesophageal region. Results of preserving the parathyroid function were evaluated at 3 months after surgery based on the necessity of calcium replacement. In 30 cases (46.0%), the function of the parathyroid glands was preserved and calcium replacement was not needed. In 11 cases, the parathyroid glands were preserved, however, calcium replacement was needed. Preserving the superior thyroid vein might be more important. In 23 cases, the parathyroid glands were totally removed for various reasons. Far advanced primary tumor with bilateral invasion, radical radiotherapy and tracheotomy before surgery often made the preservation difficult.