TY - JOUR
T1 - Surgical management of posterior pharyngeal wall carcinomas
T2 - Functional and oncologic results
AU - Julieron, Morbize
AU - Kolb, Frédéric
AU - Schwaab, Guy
AU - Marandas, Patrick
AU - Billard, Valérie
AU - Lusinchi, Antoine
AU - Ridant, Anne Marie Le
AU - Luboinski, Bernard
PY - 2001/1/30
Y1 - 2001/1/30
N2 - 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.
AB - 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.
KW - Free flap reconstruction
KW - Pharyngeal neoplasm
KW - Pharyngectomy
KW - Posterior pharyngeal wall
KW - Squamous cell carcinoma
KW - Surgical flaps
UR - http://www.scopus.com/inward/record.url?scp=0035191263&partnerID=8YFLogxK
U2 - 10.1002/1097-0347(200102)23:2<80::AID-HED1002>3.0.CO;2-3
DO - 10.1002/1097-0347(200102)23:2<80::AID-HED1002>3.0.CO;2-3
M3 - Article
C2 - 11303637
AN - SCOPUS:0035191263
SN - 1043-3074
VL - 23
SP - 80
EP - 86
JO - Head and Neck
JF - Head and Neck
IS - 2
ER -