Surgical options for Hypopharyngeal Cancers

As is apparent from the treatment algorithms, many surgical options can achieve clear margins and preserve laryngeal function

Surgical options include:

• Transoral endoscopic microsurgery (cold steel) or extended Bovie via Lindholm
• Transoral microscopic CO2 laser surgery
• TORS (Transoral robotic surgery)
• Suprahyoid approach and resection (page 9): May be considered to access and to resect high posterior wall hypopharyngeal tumours
• Lateral pharyngotomy
• Supracricoid laryngectomy (Requires swallowing therapy expertise)
• Total laryngectomy

Type of surgery depends on

• Tumour factors
  • Site
  • Cartilage invasion
  • Stage

• Prior therapy
  • Radiation
  • Partial pharyngectomy

• Patient factors
  • Pulmonary status (tolerate aspiration)
  • Fitness, age
  • Nutritional status
  • Cognitive status (To work with Speech and Language Therapist)

• Institutional support
  • Surgical expertise
  • Availability of CO2 laser / transoral microsurgery / TORS
  • Speech and swallowing support
  • Tracheoesophageal speaking valves
  • Oesophagectomy, gastric pull-up, PEG

Index: Clinical Practice Guidelines for Hypopharyngeal Cancer

Resource Appropriate Hypopharynx Cancer Guideline Scenarios