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Master Thesis

Pharyngolaryngectomie totale avec ou sans reconstruction par lambeau musculo-cutané d'agrandissement du pharynx : résultats fonctionnels et carcinologiques

Abstract : Objectives : Total pharyngolaryngectomy (TPL) is a first line treatment for hypopharyngeal squamous cell carcinoma (HSCC) locally advanced. Neopharynx can be enlarge by flap to decrease the risk of post operative dysphagia. The aim of this study was to compare functionnal and oncologic results of TPL with or without. Methods : All patients treated by TPL with or without enlargement musculocutaneous pedicled flap for HSCC between January 2007 and July 2014 were included. Clinical data, functionnal data (exclusive oral feeding recovery, vocal rehabilitation by tracheo oesophageal puncture, post operative oesophageal dilatation), morbidity and oncologic data (histologic outcomes, 5 year rates for overall survival (OS), disease free survival (DFS) and local control (LC)) were analyzed. Results : Forty-two patients (15 TPL alone and 27 TPL with flap : 20 pedicled musculocutaneous pectoralis major flaps and 7 pedicled musculocutaneous latissimus dorsi flaps) were included. Tumour size was higher in TPL with flap group (37.6 ± 7.05 mm vs 52.4 ± 14 mm ; p=0.01). It was no significative difference between the groups for exclusive oral feeding recovery (p=1) and success of tracheo-oesophageal voice rehabilitation (p=0.42). Oesophageal dilatation was more frequent in TPL alone group (p=0.22). Pharyngocutaneous fistula rate was comparable in both groups (p=0.74). Positive margin resection rate was higher in TPL with flap group (0% vs 18% ; p=0.14). Five year rates of OS, DFS and LC were respectively of 59.6%, 91.9% et 100% in TPL alone group and 61.5%, 62.7% et 81.9% in TPL with flap group. Conclusion : Pharyngeal enlargement by musculocutaneous flap have good functionnal results for bigger tumour with larger pharyngeal mucosa resection. In these cases, conservation of a strip of pharyngeal posterior wall mucosa expose to the risk of positive margin resection.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01244863
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Submitted on : Wednesday, December 16, 2015 - 1:02:25 PM
Last modification on : Wednesday, August 23, 2017 - 4:30:53 PM
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David Fonmarty. Pharyngolaryngectomie totale avec ou sans reconstruction par lambeau musculo-cutané d'agrandissement du pharynx : résultats fonctionnels et carcinologiques. Médecine humaine et pathologie. 2015. ⟨dumas-01244863⟩

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