Management of hypopharyngeal cancer involving the cervical esophagus Lei Dapeng Pan Xinliang Xu Fenglei Liu Dayu Zhang Liqiang Li Xuezhong Xie Guang Luan Xinyong Chinese Journal of Otolaryngology, Head and Neck Surgery, September 2005, Vol. 40, No. 9 Objective To summarize the management experience of hypopharyngeal cancer involving the cervical esophagus. Methods Retrospective analysis of the surgical treatment of 48 patients with hypopharyngeal carcinoma involving the cervical esophagus from 1989 to 2000, including 38 males and 10 females, aged 26-71 years, with an average age of 54.3 years. There were 33 cases of carcinoma of the pyriform fossa, 14 cases of carcinoma of the posterior wall of the hypopharynx, and 1 case of carcinoma of the posterior ring, all without distant metastasis. All of them were T4M0 stage according to the UICC 1997 TNM staging criteria, including 28 cases of cN0, 15 cases of cN1, and 5 cases of cN2. Total laryngectomy was performed in 8 cases, and partial laryngectomy with laryngeal tracheal flap was performed in 17 cases to repair the hypopharynx, and laryngeal function was preserved in 23 cases. Modified neck clearance was performed in all cases, including 38 cases of unilateral clearance and 10 cases of bilateral clearance. The thyroid lobes on the affected side were removed in 42 cases. The hypopharyngeal esophageal defects were repaired by laryngotracheal flap in 11 cases, pectoralis major muscle flap in 13 cases, laryngotracheal flap + pectoralis major muscle flap in 6 cases, lamellar skin flap + pectoralis major muscle flap in 10 cases, gastric epigastric anastomosis in 3 cases, and superior colonic migration in 5 cases. The postoperative radiation therapy was given in 55-75 Gy. The results of Lei Dapeng, Department of Otolaryngology, Qilu Hospital, Shandong University, confirmed 20 cases of cervical lymph node metastasis. Pathological diagnosis: 18 cases of highly differentiated squamous cell carcinoma, 24 cases of moderately differentiated squamous cell carcinoma, and 6 cases of lowly differentiated squamous cell carcinoma. Postoperative complications included one case of thoracic incision dehiscence and 10 cases of pharyngeal fistula. The survival rate was calculated by direct method, and 2 cases were lost to follow-up and counted as death. The survival rates at 3 and 5 years for the whole group were 52.1% (25/48) and 27.3% (12/44), respectively. The survival rates at 3 and 5 years were 65.2% (15/23) and 33.3% (7/21) for the group with preserved laryngeal function and 40.0% (10/25) and 21.7% (5/23) for the group without preserved laryngeal function. 23 patients had preserved laryngeal function, 15 patients had their tracheal tubes removed and full laryngeal function (articulation, breathing, swallowing protection) restored, and 8 patients had partial laryngeal function restored (articulation, breathing, swallowing protection). The rate of extubation was 65.2% (15/23), and partial laryngeal function (articulation and swallowing protection) was restored in 8 patients. Conclusion The treatment of hypopharyngeal cancer involving the cervical esophagus is based on the comprehensive treatment of surgery + radiotherapy, and the laryngeal function should be preserved as much as possible, and if the laryngeal function cannot be preserved, the laryngeal tracheal flap or the combined lamellar skin flap or pectoralis major muscle flap can be used to repair the defect of the cervical esophagus of hypopharynx.