A new lateral cervical approach for salvage total laryngo-pharyngectomy

Total laryngectomy with subtotal pharyngectomy is the standard treatment of persistent/recurrent laryngeal and/or pharyngeal cancer. Salvage surgery can be complicated by pharyngo-cutaneous fistula because of previous treatment. The aim of this paper was to verify the feasibility of salvage total laryngectomy with subtotal pharyngectomy with a minimally invasive technique through a lateral cervical approach using the same skin incision used for resection of primary, synchronous neck dissection and pharyngeal flap reconstruction. This approach allowed harvesting of the anterior-myocutaneous flap including skin, subcutaneous tissue, platysma, anterior jugular veins, sterno- and homohyoid muscle in order to preserve as much tissue not involved by the tumour as possible. This technique is feasible and safe; further studies should confirm its advantages in terms of reduction of complications.