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Organ preservation surgery for pyriform sinus carcinoma with vocal cord fixation: functional and oncological outcomes

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Background

Pyriform sinus carcinoma with vocal cord fixation is stratified as stage T3 and above, and non-surgical treatment is generally preferred according to the guidelines, aiming to preserve laryngeal function. However, long-term survival is often compromised by deep infiltration of the tumor. Vertical hemipharyngolaryngectomy (VHPL) was previously reported to be a feasible surgical approach for organ preservation. The aim of this study was to evaluate the functional and oncological outcomes of VHPL in patients.

Methods

Patients who underwent VHPL type II (total VHPL, which includes the removal of a vertical section of the thyroid cartilage through the anterior commissure to the upper border of the cricoid cartilage) for pyriform sinus cancer with vocal cord fixation at the authors’ institute between 1999 and 2015 were retrospectively analyzed. Functional outcomes concerning swallowing and decannulation were evaluated. Successful functional preservation was defined as laryngeal preservation as well as oral realimentation and decannulation within 6 months after surgery. The oncological outcomes were measured by overall survival (OS) and disease-free survival (DFS) with Kaplan–Meier curves and comparisons were performed between the VHPL-treated patients and patients who underwent non-surgical treatment within the same period.

Results

A total of 23 patients (stage T3, 17 patients; stage T4, 6 patients) whose initial treatment was VHPL type II were studied, and a cohort of 123 patients was selected as the control group. Pedicle and free flap reconstructions were performed on 12 and 11 patients, respectively. Postoperative radiation and chemoradiation was performed on 14 and 3 patients, respectively. Flap failure and pharyngeal fistula were detected in 2 and 5 patients, respectively. Oral realimentation and decannulation within 6 months were achieved in 82.6% (19 patients) and 87.0% (20 patients) of patients, respectively, and the total functional preservation rate of the study cohort at 6 months was similar to that of the control cohort. (78.3% vs. 82.9%, p = 0.28). After a median follow-up period of 49 months, 9 recurrences and 8 deaths had occurred in the study cohort. According to the Kaplan–Meier analysis, the study cohort had superior DFS (5-year DFS 60.3% vs. 44.6%, p = 0.04) and similar OS (5-year OS 63.8% vs 57.0% p = 0.28) compared with those in the control group.

Conclusion

VHPL yielded favorable oncological and functional outcomes in patients with unilateral pyriform sinus carcinoma and vocal cord fixation.

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Funding

The study was funded by the CAMS Innovation Fund for Medical Sciences (CIFMS) (Grant no.2016-I2m-1-002).

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Author notes

  1. Siyuan Xu and Ying Huang have contributed equally to this work.

Authors and Affiliations

  1. Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, 100021, People’s Republic of China

    Siyuan Xu, Ying Huang, Hui Huang, Jiaxin Qian, Kai Wang, Yuehuang Wu, Xiaolei Wang, Zhengang Xu, Shaoyan Liu & Jie Liu

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  1. Siyuan Xu
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  2. Ying Huang
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  9. Shaoyan Liu
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Contributions

SYX participated in the design of the study, data collection and paper writing. YH participated in the design of the study and paper writing. HH participated in the paper writing and statistical analysis. QJX participated in the data collection and helped to draft the manuscript. WKAND YHW participated in the statistical analysis and quality control of data. XLW and ZGX participated in the design of study and manuscript editing. SYL participated in the data analysis and interpretation and manuscript review. JL participated in the design of the study and helped to revise the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Shaoyan Liu or Jie Liu.

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The authors have no conflicts of interest to disclose.

Ethics approval

The study was approved by the Ethic Committee of the Cancer Hospital, Chinese Academy of Medical Sciences.

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Each patient was consented for use of their images or pathology information for the purpose of education and research.

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Xu, S., Huang, Y., Huang, H. et al. Organ preservation surgery for pyriform sinus carcinoma with vocal cord fixation: functional and oncological outcomes. Eur Arch Otorhinolaryngol 279, 3611–3617 (2022). https://doi.org/10.1007/s00405-021-07182-w

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  • DOI: https://doi.org/10.1007/s00405-021-07182-w

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