ABSTRACT
Hypopharyngeal tumours have one of the worst survival rates for any head and neck site and are associated with significant morbidity. This is due to several factors. Early symptoms are often vague and many patients are diagnosed at a late stage in the disease when the local tumour is advanced and nodal metastases are frequently present. Progressive dysphagia over several months prior to diagnosis may reduce the patient to a poor physical state with a correspondingly increased risk of morbidity and mortality following treatment. The larynx is frequently involved, although in the early stages of the disease hoarseness is not a common symptom. If radiotherapy is given for anything other than a small lesion, particularly near the lower part of the hypopharynx, there is a significant risk of continued dysphagia because of postradiation circumferential cicatrization. For those patients who recur after primary radiotherapy, salvage surgery is associated with an increased risk of complications and may not be feasible. Primary total laryngectomy with partial or total pharyngectomy may offer the best chance of cure but with a very severe reduction in quality of life. The optimum curative treatment for more advanced disease at this site involves one of the most complex operations in head and neck surgery which is associated with significant morbidity and mortality.
