Hypopharynxkarzinome und Radikaloperation : kann man auf die Kehlkopftotalexstirpation verzichten ?

BACKGROUND: Patients with hypopharyngeal carcinoma have a poor prognosis. In reviewing patients treated at our clinic from 1977 to 1990, we wanted to find out how this prognosis is influenced by the degree of surgical radicality (total vs. partial laryngectomy). METHODS: From 1984 to 1990, 46 patients with carcinoma of the hypopharynx were treated at the ENT department of ZKH St.-Jurgen-Strasse in Bremen and followed up for 5 years. All patients had been treated by radiotherapy and all, except 3 patients, had had additional surgery of the lymph nodes. In 14 patients the primary tumor had been only irradiated (group 1), and in 32 patients it had been removed by surgery (groups 2 and 3). Surgical removal of the primary tumor had been combined with partial resection of the hypopharynx and of the larynx only (group 2) or with total laryngectomy (group 3). There were no differences in tumor stages between groups 1 and 3, which comprised mainly stages III and IV. Stages I and II were overrepresented in group 2. RESULTS: The 5-year survival rate was 37% for all patients, and for groups 1, 2 + 3, 2 and 3, 31%, 40%, 58%, and 28%, respectively. DISCUSSION: These results are superior to those obtained between 1977 and 1983 for 49 patients who had been treated either by excision of the primary tumor combined with laryngectomy, or by irradiation alone, without neck dissection. The respective 5-year survival rates were 19% for all patients, 11% for the group of radiotherapy alone, and 33% for patients undergoing additional surgery. CONCLUSION: In our opinion less radical surgical procedures are justified for the treatment of hypopharyngeal cancer.