Comparison of trans oral surgery and partial pharyngectomy with primary closure for early stage hypopharyngeal cancer

Abstract

Background: Recent developments in transoral surgery （TOS） have improved outcomes in early-stage hypopharyngeal cancer. To date, however, indications for TOS and partial pharyngectomy with primary closure （PP-PC）, which is also used in these early-stage diseases, have not been considered in detail. Here, we investigated whether TOS could be used as minimally invasive surgery while maintaining outcomes comparable to those of PP-PC. Methods: This was a single-center retrospective case control study. Median follow-up period was 59.4 months （1.2-174） for TOS and 88.8 months （3.6-158.4） for PP-PC. Patients who received initial surgical treatment for hypopharyngeal cancer were recruited from 2002 through 2014. Among these patients who underwent TOS or PP-PC, cT1-3N0M0 was included. Those with histopathological invasion of the muscularis propria were excluded. Of 117 consecutive cases, 87 cases were treated with TOS and 30 with PP-PC. Median age was 66 years （42-88）. Lesions were in the pyriform sinus （PS） in 91 cases, posterior wall （PW） in 18, and postcricoid area （PC） in 8. cT classification was cT1 in 62 cases, cT2 in 51, and cT3 in 4. We compared patients by patient background; prognosis, including postoperative complications; Results: Median operation time was 40 minutes （12-240） for TOS and 118 minutes （58-250） for PP-PC. Postoperative complications occurred in 10 cases （10/87, 11.5％） with TOS and 10 （10/30, 33.3％） with PP-PC （P ＝ 0.0275）. postoperative hospital stay was 7 days （4-137） with TOS and 15 days （9-37） with PP-PC （P ＝ 0.002）. function Five-year overall survival rate for 0.99）. hypopharyngeal cancer （cT1N0, cT2N0 and some cT3N0 without muscular infiltration）.