Open surgery may be performed to remove more advanced cancers and for people who cannot tolerate chemoradiation.
Pharyngectomy and Laryngectomy
If cancer has spread to other parts of the pharynx, surgeons may remove all or part of the pharynx with a procedure called pharyngectomy. If the larynx is affected, surgeons may perform a laryngectomy, in which they remove all or part of that organ.
If fine needle aspiration or imaging shows that hypopharyngeal cancer has spread to nearby lymph nodes in the neck, surgeons may remove them with a procedure called a neck dissection. They may also remove lymph nodes if they suspect cancer has spread and want to determine the extent of the spread.
Surgeons can repair, or reconstruct, the pharynx and the wall of the larynx during open procedures. One way doctors do this is by replacing small areas of soft tissue removed during surgery with nearby healthy tissue, called a flap. Nearby flap tissue may come from a muscle in the chest.
A surgeon may take flap tissue and its blood vessel supply from a distant part of the body—the forearm, for example—and then carefully attach it to vessels in the pharynx or larynx to close the wound and restore blood flow.
People who have their entire larynx removed no longer have vocal cords, which are two thin structures that stretch horizontally across the larynx that vibrate as you exhale. These vibrations create sounds that help you speak. People who have their larynx removed are candidates for voice restoration or other methods of creating the sound vibrations needed for speech.
Sometimes hypopharyngeal cancer can press on or grow into the larynx, which is the narrowest part of the airway. This can block airflow into and out of the lungs.
To improve airflow, surgeons may perform a tracheostomy. During this procedure, they make an incision in the trachea to create a small opening, called a stoma, through which they place a tube. Instead of inhaling and exhaling through the nose and mouth, people who’ve had a tracheostomy breathe through this tube.
A tracheostomy may be temporary or permanent, depending on whether other treatments, such as surgery, radiation therapy, or chemoradiation, are used to remove or shrink the hypopharyngeal cancer.