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Introduction: The aim of this study was to evaluate the results of the initial surgical treatment and salvage treatment for advanced laryngopharyngeal cancer., Methods: From 1984 to 1997, primary surgical treatment was undertaken in 60 patients. 75 patients underwent surgical salvage following radiotherapy., Results: 55/135 patients (40.7%) experienced local regional relapse. The overall survival at 5 years was 43.9% in the first group of patients treated initially with surgery. In the group of patients treated with salvage surgery, the overall survival at 5 years was 40.2%. A multivariate analysis showed that involved lymph nodes (p = 0.0004), a nutritional score inferior to 5 (p = 0.03), positive resection margins (hazard ratio 2.05; 95% c.i. 1.03 to 4.04 ; p = 0.03), a local-regional relapse (p = 0.04) and appearance of metastasis (p = 0.03) were independent risk factors for overall survival. Survival is dependent from each factor, and each factor is independent from each other Stenosis was rare: 5.1% in the present series. A pharyngocutaneous fistula developed in 49.6% of patients. After a multivariate analysis, the site of the tumor (odds 2.26; 95% c.i. 1.05 to 4.85; p = 0.03) had an influence for apparition of a fistula., Conclusion: Initial surgical surgery and salvage surgery of respectively 43.9% and 40.2% overall survival compares favorably with the literature. Despite progress made with reconstruction, morbidity is still elevated in a selected group defined after analysis of pronostic factors.

The multidisciplinary management of patients following pharyngolaryngeal surgery is an essential condition for its functional and socio-professional success. Early, overall rehabilitation, geared to each type of exeresis and to the personality of each patient, will enable both the voice and swallowing to regain their autonomy. A series of 195 patients after partial or reconstructive laryngectomy or pharyngectomy is analysed. The maintenance of a functional crico-arytenoid unity, the preservation of the mucosal sensitivity, the establishment of a facilitating posture and the dynamisation of the neoglottic sphincter are all equally important elements requiring the mobilisation of the entire health care team.

The authors report four cases of severe deglutition disorders after partial laryngectomy. Three had collagen injection and one had a plastic reconstruction. They propose to use dynamic imagery in order to have a better selection of the patients.

Tumors of the amygdaline region were up until now most often treated by transmandibular buccopharyngectomy (TMBP) with a systematic sacrifice of the mandibular angle. This exercise justified by wide carcinological imperatives, a larger surgical facility and simple immediate postoperative follow-up, in fact systematically shows a substantial esthetic and functional prejudice. This principle was reinforced by the occurrence of osteitis during the first attempts of osseous reconstruction using steel wires opposite the mandibular angle (Dargent, Charachon, 1963). In 1989, Gehanno and Beauvillain published a mandibular conservation technique by vertical paramedian osteotomy, right in front of the mental nerve, shifted from the future field of radiation, with osteosynthesis by titanium plates. This technique appeals to us because it is easy to use, reliable and carcinologically safe. We have currently adopted it with satisfaction for 8 of our patients over an 18-month period, without any case of osteitis and with both good esthetic and functional results.

From january 1976 to december 1986, 78 patients were treated surgically for squamous cell carcinoma of the lateral buccopharyngeal junction without chemotherapy at first. 36 patients were treated by primary surgery with post-operative radiotherapy and 31 patients were treated by recovery surgery. Post-operative course was uncomplicated in 41% of cases (39% in primary surgery, 43% in recovery surgery); in 14% of cases serious local complications were observed (11% in primary surgery, 17% in recovery surgery). Carcinological failures appeared in 46% of cases in primary surgery and in 70% of cases in recovery surgery. Three years and five years actuarial survival rate were 45% and 39% respectively in recovery surgery. Prognostic factors are studied: resection quality, histological metastasis in lymph nodes. The authors emphasize on the best control of the big tumors in primary surgery and on the best results with small ulcerated infiltrant carcinoma.