Surgery for Hypopharyngeal Cancer

Sometimes, minimally invasive surgery is followed by radiation therapy, in which high-energy beams destroy cancer cells. Radiation therapy can be used with or without chemotherapy, which are drugs that work to kill cancer cells throughout the body. This combined approach is called chemoradiation.

Surgeons may recommend an open procedure, in which an incision is made in the neck, to manage more advanced hypopharyngeal cancers. Open surgery may also be performed to remove cancer in people who cannot tolerate chemoradiation.

General anesthesia is typically required for all surgical procedures.

Surgeons use several different minimally invasive procedures to manage early hypopharyngeal cancer and remove small tumors.

Endoscopic Transoral Resection

In endoscopic transoral resection, a surgeon removes cancerous tissue with an endoscope while viewing the anatomy of the area through a microscope.

During this procedure, the surgeon inserts the endoscope through the mouth and into the throat until it reaches the hypopharynx. He or she then places small surgical tools into the scope to remove the tumor.

Transoral Laser Microsurgery

Surgeons may perform transoral laser microsurgery to manage small hypopharyngeal cancer tumors. For this procedure, doctors place a laser through an endoscope and use it to remove or destroy tissue.

Transoral Robotic-Assisted Surgery

Surgeons may use robotic-assisted surgery to remove hypopharyngeal tumors. This approach gives them an excellent view of the lower portion of the pharynx and enhances their ability to perform delicate procedures.

Doctors at NYU Langone’s Robotic Surgery Center use a system that consists of tiny surgical instruments mounted on robotic arms. Another arm contains a camera that creates magnified, three-dimensional images on a computer monitor. This guides the surgeon during the procedure.

The surgical tools and camera are inserted through the mouth and into the lower portion of the throat. The surgeon controls these instruments and the camera from a console in the operating room.

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.

Neck Dissection

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.

Reconstruction

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.

Tracheostomy

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.

The time it takes to recover from surgery varies, depending on the type of procedure performed and whether reconstructive surgery is necessary. For example, if surgeons use an endoscopic approach to manage early hypopharyngeal cancer, you may be able to go home the same day.

If open surgery and reconstruction are needed, you may need to remain in the hospital for up to a week, so doctors can monitor your recovery and manage any pain or discomfort.

Rehabilitation can be an important part of care after hypopharyngeal cancer surgery, depending on the type of procedure performed. Structural changes made in the hypopharynx and temporary swelling and inflammation in throat tissues due to surgery can affect your ability to swallow and may interfere with speech. NYU Langone speech pathologists help you adjust to any changes in your pharynx or larynx and to restore your ability to speak and swallow.