The results of treatment of 230 cases of carcinoma of the hypopharynx seen at the University of Toronto and the Princess Margaret Hospital, between the years 1951 and 1963, are presented. The recommendations of the American Joint Committee have been followed in the classification of these tumours: 127 of the 230 were located in the pyriform sinuses.The overall five-year survival rate for lesions of the pyriform sinus was 9% as opposed to 20% for tumours in the other regions of the hypopharynx. Surgical treatment alone was used in 44 of these cases, and the five-year net survival figure was 23%. This compared favourably with the overall survival figure of 8% for those treated primarily by radiotherapy.Elective preoperative irradiation leads to improved survival rates. Palliation for Stage IV lesions should be achieved by radiography. The two-stage method of surgical reconstruction remains the surgical procedure of choice despite current enthusiasm for the use of visceral transplants.

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Verrucous carcinoma (Ackerman's tumor) of the larynx: diagnostic and therapeutic considerations.

Verrucous carcinoma (Ackerman's tumor) is a low-grade malignant lesion with distinct clinical and pathologic features, distinguishing it from other well-differentiated squamous cell carcinomas. Much of the confusion surrounding its natural history, response to therapy, and anaplastic transformation may be ascribed to the failure of critically reviewing accepted diagnostic criteria. A series of 44 patients with verrucous carcinoma of the larynx is presented, 18 of these being updated results of previously reported patients. Ackerman's tumor, although not radioresistant, seems less radiosensitive than ordinary squamous cell carcinoma. The tumor's rounded, pushing margins and inability to metastasize would seem to favor endoscopic removal, saving partial laryngectomy procedures for those lesions that cannot be managed endoscopically. Extensive lesions that would require total laryngectomy for complete removal of the tumor should be treated by primary radiotherapy. It is our belief that total laryngectomy should only be performed in large lesions that fail to respond to radiotherapy and whenever medical considerations preclude partial laryngectomy procedures.

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Verrucous carcinoma of the larynx management by radiotherapy and surgery.

Verrucous carcinoma is an unusual and distinct variant of well differentiated squamous cell carcinoma, and accounts for approximately 1 to 2% of all primary squamous cell carcinomas of the larynx. There has been considerable controversy regarding the role of radiotherapy in the managment of these tumors as they are said to be radioresistant, and in a number of instances "anaplastic transformation" has apparently occurred following such therapy. We have reviewed 18 patients with verrucous carcinoma of the larynx in which eight received surgical therapy alone, eight received radiotherapy alone, and two received combined therapy. We conclude that radiotherapy and surgery are equally effective in eradicating the disease. "Anaplastic transformation" of these tumors represents a small but nevertheless real risk following radiotherapy. Accordingly, our current therapeutic policy is to treat by surgical excision those smaller tumors which can be removed by conservation laryngectomy procedures, reserving radiotherapy for those large tumors which would require total laryngectomy if treated surgically.

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Leiomyosarcoma of the cervical trachea. Report of a case with reconstruction using a latissimus dorsi island flap.

A case of leiomyosarcoma of the cervical trachea is described, detailing clinical presentation, pathologic diagnosis and surgical management. The rarity of this tumor in this location accounted for difficulties in clinical diagnosis and pathologic classification. Surgical treatment involved resection of two thirds of the circumference of the infracricoid trachea, with partial resection of the cricoid cartilage and thyroid gland. The defect was reconstructed using bilateral "butterfly" advancement flaps and a latissimus dorsi myocutaneous island flap. The technique and advantages of the latissimus dorsi flap are briefly described.

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Management of patients with long-term tracheotomies and aspiration.

The purpose of this study was to develop a management protocol for patients with long-term tracheotomies and aspiration, in order to develop clinical criteria for extubation and reduction of aspiration-related complications. We studied 39 patients with tracheotomies in place for over 3 months, 28 of whom completed management. Patients were classified according to degree of impairment and managed with the aims of avoiding aspiration and performing extubation whenever feasible. Criteria for choosing various management strategies are presented.

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