A Classification System for the Reconstruction of Vertical Hemipharyngolaryngectomy for Hypopharyngeal Squamous Cell Carcinoma

Objective

To evaluate microvascular reconstruction of a vertical hemipharyngolaryngectomy (VHPL) defect for hypopharyngeal squamous cell carcinoma.

Design

Retrospective analysis of medical records.

Setting

Tertiary care referral center.

Patients

Thirty-two patients who underwent a VHPL.

Main Outcome Measures

Assess the surgical technique and safety of VHPL and review the functional parameters of swallowing and decannulation.

Results

The classification was composed of 3 types of VHPL according to the extent of resection: limited VHPL (type I), resection at the lateral border of the conus elasticus to preserve both vocal cords (n = 10); total VHPL (type II), removal of a vertical section of the thyroid cartilage through the anterior commissure to the upper border of the cricoid cartilage with preservation of 1 vocal cord (n = 12); and extended VHPL (type III), inclusion of a supraglottic laryngectomy (type IIIa) (n = 6) or partial cricoid cartilage resection (type IIIb) (n = 4). A radial forearm free flap that included the palmaris longus tendon was used for reconstruction in 31 patients, and an anterolateral thigh flap was used in 1 patient. There was no perioperative mortality, and there was 100% free flap survival. Oral realimentation and tracheotomy weaning were achieved a mean of 33 and 32 days postoperatively, respectively. In 25 patients observed for longer than 6 months, the recurrence rate was 28% (7 of 25), and 5-year disease-specific survival was 64%.

Conclusion

Microvascular reconstruction of VHPL offers a wider resection with promising functional results for hypopharyngeal carcinoma.