ObjectiveTo investigate the selection of surgical approaches and throat defect repair methods for hypopharyngeal carcinoma with different T stages.

MethodsThe clinical data of 65 patients with hypopharyngeal cancer who underwent operational repairment were retrospectively analyzed.Of all patients who aged 42-77 years, 64 were males and 1 was female, 1 case had stage Ⅰ, 8 cases had stage Ⅱ, 31 cases had Ⅲ, 25 cases had stage Ⅳ of hypopharyngeal carcinoma and no distant metastasis was detected.On surgical methods, 1 case received total laryngectomy with partial esophagectomy, 24 cases received total laryngectomy with partial hypopharynx, 36 and 4 cases were subjected to partial hypopharynx and partial hypopharynx, respectively.All patients underwent neck dissection.On surgical approaches: esophageal approach in 1 case, pharyngeal approach in 2 cases, epiglottic anterior space approach in 6 cases, retrocricoid approach in 9 cases, supraglottic space approach in 11 cases, pharyngeal combined thyroglossal membrane approach in 13 cases, thyrochondral dehiscence combined with epiglottic anterior space approach in 17 cases and combined approach in 6 cases.The residual laryngotracheal tissue flap, submental island flap and pectoralis major muscle flap were used to reconstruct the function of pharynx and part of esophagus, and epiglottis, band myofascial flap and thyroid perichondrium flap were used to repair the laryngeal cavity.No radiotherapy was given in stage Ⅰ and Ⅱ, and postoperative adjuvant radiotherapy was given in stage Ⅲ and Ⅳ (dose 50-60 Gy).Some cases were treated with platinum neoadjuvant chemotherapy before operation and concurrent radiotherapy and chemotherapy after operation.

ResultsThe 3-year overall survival rate was 63.9%, the disease-free survival rate was 51.8%, the 5-year overall survival rate was 42.6%, and the disease-free survival rate was 41.7%.Laryngeal function retention rate was 61.5%, and tracheal casing expulsion rate was 38.5%.Postoperative pathology confirmed that the positive rate of cervical lymph nodes was 66.2%, and the incidence of pharyngeal fistula was 9.2%.The average time of gastric tube removal was 21.8 days, and 2 patients had anastomotic stenosis.

ConclusionsAppropriate surgical approach and throat repair methods according to different stages of hypopharyngeal carcinoma can be beneficial in operational exposure, mucosa preservation, defects narrowing, surgical trauma reduction, and can improve the laryngeal function retention rate of hypopharyngeal carcinoma while ensuring the survival rate of patients.