Therapeutic effect on pyriform sinus carcinoma resection via paraglottic
space approach: Results of a single-centre study of 93 patients
Abstract
Objective To analyse the surgical indications, surgical efficacy and key
influencing factors of prognosis of using a novel surgical approach for
pyriform sinus carcinoma resection utilising the paraglottic space.
Methods From 2014 to 2017, 93 patients with squamous cell carcinoma
originating in the pyriform sinus were resected through the paraglottic
space approach. The postoperative laryngeal function preservation,
complications, survival rate and prognostic factors were analysed.
Results The 2, 3 and 5 year overall survival rates of the patients were
77.2%, 61.6% and 47.4%, respectively. The univariate analysis of
survival rate showed that primary tumour T stage and N stage had a
statistically significant effect on the survival rate of patients
(P=0.047 and P<0.001, respectively). Multivariate analysis
with the Cox regression model revealed that N stage is an independent
risk factor for postoperative survival (P=0.042). The preservation rate
of laryngeal function was 65.6% (61/93). Pharyngeal fistula incidence
was 4.3% (4/93). Systemic distant metastasis and second primary cancer
were found to be the main causes of death. Conclusions As a novel
surgical approach for the resection of pyriform sinus carcinoma, the
paraglottic space approach can better expose the tumour, effectively
improve the retention rate of laryngeal function, reduce the incidence
of pharyngeal fistula and result in the better recovery of postoperative
swallowing function with satisfactory long-term survival. This surgical
approach can be applied in patients with lesions that do not involve the
paraglottic space. N stage is an independent risk factor for
postoperative survival. Key Points: In this study, we present a novel
surgical approach for hypopharyngeal carcinoma resection utilizing the
paraglottic space. The paraglottic space is a natural anatomical
space.If the thyroid cartilage plate is cut obliquely and pulled
posterolaterally, the paraglottic space can be easily exposed. The
paraglottic space approach can help expose neoplasms under direct vision
and save mucosa during surgery while sufficiently preserving laryngeal
function. In our study, application of the paraglottic approach
significantly reduced one of the serious postoperative complications,
pharyngocutaneous fistula. This approach can be proposed as a promising
candidate for resection of early T stages of hypopharyngeal carcinoma.