Principles of surgical management of cancer of the pharyngeal walls

Abstract

The clinical data in a series of 48 cases of cancer of the pharyngeal walls is presented. The author concludes that local recurrences were due to four principal causes: (1) Failure to remove unrecognized local extension of the tumor along muscle planes, fascial planes or nerves; (2) failure to remove lymphatic structures in the vicinity of the primary tumor, particularly the retropharyngeal nodes; approximately 40% of the pharyngeal wall cancers in this series had positive retropharyngeal nodes; (3) failure to remove areas of in situ or early invasive cancer; (4) implantation of cancer cells in the operative wounds. The emphasis in the surgical approach has been shifted from concern for metastatic nodes in the lateral neck to wider resection of structures between the carotid arteries including retropharyngeal node dissection. This has apparently resulted in a significant decrease in the incidence of local recurrence and an apparent increase in survival rates.