Extended voice-sparing surgery in selected pyriform sinus carcinoma: techniques and outcomes.

BACKGROUND: Organ-preservation approaches are frequently favored in the treatment of advanced pyriform sinus carcinoma. In selected cases, use of free flaps allows voice-sparing surgery. METHODS: Thirteen patients underwent conservative extended laryngopharyngectomy. In 11 patients, the resection included the supraglottic larynx, whereas the whole hemilarynx was resected in 2. Reconstruction was achieved with a radial forearm free flap with the palmaris longus tendon. In hemilarynx resection, a costal graft was also used. Functional results were assessed by nasofibroscopy and swallowing videofluoroscopic tests. RESULTS: At 12 months, no patient was gastrostomy dependent, whereas 1 patient remained tracheostomy dependent. At 1, 3, and 5 years, the locoregional control was 100%, 100%, and 83%; overall survival was 69.4%, 46.3%, and 30.8%; and disease-specific survival was 81.2%, 54.5%, and 36.4%, respectively. CONCLUSIONS: In selected patients, extended conservative laryngopharyngectomy challenges the oncologic results of organ-preservation protocols and allows a good quality of life.