A classification system for the reconstruction of vertical hemipharyngolaryngectomy for hypopharyngeal squamous cell carcinoma

Objective: To evaluate microvascular reconstruction of a vertical hemipharyngolaryngectomy (VHPL) defect for hypopharyngeal squamous cell carcinoma. Design: Retrospective analysis of medical records. Setting: Tertiary care referral center. Patients: Thirty-two patients who underwent a VHPL. Main Outcome Measures: Assess the surgical technique and safety of VHPL and review the functional parameters of swallowing and decannulation. Results: The classification was composed of 3 types of VHPL according to the extent of resection: limited VHPL (type I), resection at the lateral border of the conus elasticus to preserve both vocal cords (n=10); total VHPL (type II), removal of a vertical section of the thyroid cartilage through the anterior commissure to the upper border of the cricoid cartilage with preservation of 1 vocal cord (n=12); and extended VHPL (type III), inclusion of a supraglottic laryngectomy (type IIIa) (n=6) or partial cricoid cartilage resection (type IIIb) (n=4). A radial forearm free flap that included the palmaris longus tendon was used for reconstruction in 31 patients, and an anterolateral thigh flap was used in 1 patient. There was no perioperative mortality, and there was 100% free flap survival. Oral realimentation and tracheotomy weaning were achieved a mean of 33 and 32 days postoperatively, respectively. In 25 patients observed for longer than 6 months, the recurrence rate was 28% (7 of 25), and 5-year disease-specific survival was 64%. Conclusion: Microvascular reconstruction of VHPL offers a wider resection with promising functional results for hypopharyngeal carcinoma.