Resection Management in Radical Operations for Hypopharyngeal Carcinoma

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  • 下咽頭癌の治療戦略　　下咽頭癌根治手術における切除範囲の整合性
  • 下咽頭癌根治手術における切除範囲の整合性
  • カ イントウガン コンチ シュジュツ ニ オケル セツジョ ハンイ ノ セイゴウセイ

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Abstract

Hypopharyngeal cancer has been reported to be frequently associated with cancer of the esophagus, and the rate of the double cancer is thought to be from 30% to 40%. When treating esophageal double cancer, we have to consider the balance among radicality, prognosis and QOL. The indication of esophagectomy and gastric pull-up in esophageal double cancer is thought to be from 10% to 20% because superficial carcinoma of the esophagus is high in frequency. Hypopharyngeal cancer has a propensity to spread in the submucosa far away from the main tumor. The submucosal spread is frequently blamed for the high incidence of local recurrence. Lymph flow in the pyriform sinus and posterior wall cancer moves upward to the oropharynx. Because the submucosal spread is an invisible lesion, the superior margin should be resected adequately, applying frozen section biopsy in the pyriform sinus and posterior wall cancer. Bilateral neck dissection is often performed even in cases of clinically negative necks, because it is histologically proven that occult metastasis to the cervical lymph nodes occurs in as many as 30-40% of the cases reported. It is therefore necessary to diagnose metastatic nodes carefully before an operation in the case of performing a prophylactic neck dissection. Ultrasonography is more reliable than CT or MRI for evaluating lymph node metastases. However, it is often difficult to detect the number of positive lymph nodes by ultrasonography. Indication of prophylactic neck dissection for hypopharyngeal cancer has to be rendered carefully because of the high metastatic rate and limitations of preoperative diagnosis.

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