Improvement in Treatment Results for Hypopharyngeal Cancer through the Advance of Treatment Methods-The Usefulness of Team Practice-

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  • Umeno Hirohito
    Department of Otorhinolaryngology—Head and Neck Surgery, Kurume University School of Medicine
  • Chijiwa Hideki
    Department of Otorhinolaryngology—Head and Neck Surgery, Kurume University School of Medicine
  • Sakamoto Kikuo
    Department of Otorhinolaryngology—Head and Neck Surgery, Kurume University School of Medicine
  • Nakashima Tadashi
    Department of Otorhinolaryngology—Head and Neck Surgery, Kurume University School of Medicine
  • Mori Kazunori
    Department of Otorhinolaryngology, Kinki University School of Medicine
  • Sueyoshi Susumu
    Department of Plastic, Reconstructive and Maxillofacial Surgery, Kurume University School of Medicine
  • Fujita Hiromasa
    Department of Plastic, Reconstructive and Maxillofacial Surgery, Kurume University School of Medicine
  • Inoue Yojiro
    Department of Surgery, Kurume University School of Medicine
  • Kiyokawa Kensuke
    Department of Surgery, Kurume University School of Medicine

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Other Title
  • 治療方法の進歩による下咽頭癌治療成績の向上―チーム医療の有用性―
  • チリョウ ホウホウ ノ シンポ ニ ヨル カ イントウガン チリョウ セイセキ ノ コウジョウ チーム イリョウ ノ ユウヨウセイ

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Abstract

Treatment results were analyzed in 392 hypopharyngeal cancer patients who were radically treated at Kurume University Hospital between 1960 and 2003. In the analysis, they were divided into three chronological groups: the first consisting of 37 patients treated between 1960 and 1970, the second of 122 patients treated between 1971 and 1988, and the third of 233 patients treated between 1989 and 2003. The cause-specific 5-year survival rate for the second group was 38%. In contrast, the survival rate for the third group rose to 67%. The first choice of treatment for early hypopharyngeal cancer in the first and second groups was partial pharyngectomy. However, that of the third group was CO2 laser resection or radiotherapy followed by laser resection. The cause-specific 5-year survival rate with laser surgery was 86%. Over the years, the method of reconstruction after total resection for advanced hypopharyngeal cancer has changed. At present free jejunum reconstructive surgery after total pharyngo-laryngo-esophagectomy is considered to be a safe and most stable method, because it enables resection of the primary lesion with sufficient margin as required. Failure of reconstruction by jejunum graft was detected in only three of 137 patients (2%) who received total pharyngo-laryngo-esophagectomy. In patients who received free jejunum reconstructive surgery, the rate of cause of death tied to primary or metastatic lymph node decreased by resecting the primary lesion with sufficient margin as required, bilateral neck dissection, bilateral Rouviere and paratracheal neck dissection, and post-operative radiation. The findings indicate that treatment results for hypopharyngeal cancer improved dramatically by team practice involving a head and neck surgeon, surgeon, plastic surgeon and radiation oncologist.

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