Pharyngectomy

Who is a candidate for a pharyngectomy

Your doctor will evaluate your case to determine if you are a candidate for a pharyngectomy. Scenarios where a pharyngectomy may be appropriate include:

• Patients with throat cancer — cancer of the nasopharynx, oropharynx or hypopharynx
• Patients with hypopharyngeal carcinoma
• Surgery may be the only option for patients whose cancer returned or wasn’t eliminated after chemotherapy or radiation

In many cases, you will also need chemotherapy and/or radiation in addition to surgery.

Your doctor will determine if you need a total or partial pharyngectomy based on the stage and location of your throat cancer. You may also need a laryngectomy to remove your larynx in the same procedure as the pharyngectomy.

Patients with well-contained early stage throat cancer may be candidates for a partial pharyngectomy. A laryngopharyngectomy is more appropriate for cancers that are more advanced and need the surgical removal of the entire larynx, part of the esophagectomy as well as the pharynx.

Risks of a pharyngectomy

A pharyngectomy is a major surgery, and complications can arise during or after the surgery.

Complications may include:

• Severe bleeding
• Salivary fistula — if you have had previous chemotherapy or radiation therapy, you are more likely to develop a salivary fistula where saliva leaks from the pharynx to the neck
• Blood vessel rupture
• Seroma — collection of body fluid in the neck after a drain is removed
• Hematoma — a pooling of blood outside the blood vessels that are typically caused by an injury to the wall of a blood vessel
• Infection — although rare, infection that is characterized by redness and swelling
• Narrowing of the esophageal end of a pharyngeal reconstruction
• Swallowing problems
• Blood clots — patients who have cancer are at higher risk for developing a blood clot in their leg after surgery (deep vein thrombosis), which could lead to a pulmonary embolism.

What to expect during a pharyngectomy

What you can expect during a pharyngectomy will depend on what type of pharyngectomy you will need. Different types of pharyngectomy include:

Total laryngopharyngectomy 

A total laryngopharyngectomy is the surgical removal of the entire voice box and pharynx. After the larynx and pharynx have been removed, the trachea will be sewn into your skin above the sternum. This will allow for a permanent breathing hole. To eat, your surgeon will perform a reconstructive procedure to recreate the tube that connects the mouth to the esophagus.

Total laryngectomy with partial pharyngectomy 

The larynx is removed along with part of the pharynx during a total laryngectomy with partial pharyngectomy.Most patients need a flap to reconstruct the pharynx after this procedure.

Partial hypopharyngectomy

This procedure is a partial removal of the hypopharynx that can be performed trans orally with use of laryngoscopes or a surgical robot. In some cases, a posterior partial oropharyngectomy may be performed when the tumor is confined to the posterior wall of the oropharynx. Your doctor may be able to remove the tumor from the oropharynx wall along with a rim of healthy tissue. This procedure can be performed with a surgical robot or laryngoscopes and a laser

Recovery after a pharyngectomy

Recovery after a pharyngectomy is a lengthy process. Directly after surgery, your care team will closely monitor your pulmonary function, fluid/nutritional balance and wounds in the neck, thorax and abdomen. Some patients may need a feeding tube to be placed directly into the stomach to provide nutrition in a procedure called a gastrostomy.

In most cases, reconstructive surgery is necessary to rebuild the throat after a pharyngectomy. Reconstructive surgery will help the patient swallow. Reconstructive surgery is complex due to the anatomy of the throat. The goal of reconstructive surgery of the throat is to re-establish the connection from the oral cavity to the esophagus. This can be accomplished in two different grafting techniques:

• Myocutaneous flap – Myocutaneous flaps are an area of muscle or skin that is moved from another area of the body such as the chest and implanted in the throat to rebuild the area that was removed during the procedure.
• Free flap – Tissue can also be removed from other places in the body such as the intestine to rebuild the throat after a pharyngectomy. This has become a possibility with recent advances in microvascular surgery where blood vessels from the replacement tissue are sewn together under a microscope.