A pharyngectomy is the removal of part of the pharynx. The pharynx is a region in the back of the throat that is made up of the nasopharynx (top of the throat behind the nasal cavity), the oropharynx (middle of the throat at the back of the mouth), and the hypopharynx (bottom of the throat behind the voice box, or larynx).
Pharyngectomies are done to treat cancers or abnormalities in this region. This procedure can range from more limited surgeries to remove small tumors on the side or back wall of the pharynx, to major surgeries requiring a free flap (use of distant tissue to reconstruct the removed area).
Prior to Surgery
You will receive specific instructions on when you need to stop eating and drinking, and your medication regimen before surgery.
Leading up to your surgery, your anesthesiologist will ask you a few questions so that they can create a comprehensive anesthesia plan based on your medical history.
On the day of your surgery, you will arrive at the hospital a few hours before your scheduled procedure. The nurses, anesthesiologist, and head and neck surgery team will check in with you. If you have any last-minute questions, this is a good time to ask them.
Types of Pharyngectomies
Nasopharyngectomy
This involves the removal of a portion of the nasopharynx and is rarely performed because most nasopharyngeal cancers are treated with radiation and chemotherapy. However, this procedure may be performed for small recurrent nasopharyngeal cancer or other rare nasal tumors involving the nasopharynx. It is typically performed endoscopically, as a minimally invasive procedure using a small camera through the nose.
Oropharyngectomy
Varying amounts of the oropharynx may be removed during an oropharyngectomy. Oropharyngeal surgery can be performed transorally through the mouth using a surgical robot (transoral robotic surgery/TORS), a laryngoscope (a small camera inserted into the throat through the mouth), and/or surgical laser (transoral laser microsurgery/TLM). For large tumors, an open, more invasive approach may be required, which often requires a mandibulectomy (division of the jaw) to improve exposure.
Hypopharyngectomy
Hypopharyngeal resection is usually performed alongside a laryngectomy (removal of the larynx). However, in some select cases, a partial hypopharyngectomy can be performed, through either an open approach (neck incision) or with the help of techniques like TLM or TORS.
Laryngopharyngectomy
All total laryngectomies involve removal of at least a small portion of the pharynx. In aTotal laryngectomies involve the removal of the entire larynx and a portion of the pharynx. In advanced tumors, laryngopharyngectomies can involve significant segments of the pharynx, which require a free flap for reconstruction.
Read more about Partial & Total Laryngectomy.
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Risks
As with any procedure, there are risks in undergoing a pharyngectomy.
- Bleeding (including Hematoma)
Some mild bleeding from the mouth or nose can be expected for the first couple days after surgery. However, if there is severe bleeding after the procedure, the surgeon might need to quickly take the patient back to the operating room to stop the bleeding. Mild bleeding in the neck or small blood collections under the skin (hematomas) can often be observed and do not require surgical intervention. - Seroma
This is a collection of normal body fluid in the neck that occurs after a surgical drain is removed. This can be treated with observation, as the body will usually resorb it, or repeated needle aspiration to drain the fluid. - Infection
Infections following this surgery are quite rare. Still, as with any surgical procedure, there is always a risk of an infection after the surgery. This might require antibiotics and/or drainage of the infection. - Salivary Fistula
This term is used to describe when saliva is leaking from the pharynx (throat) into the neck. The chances of this increase if a patient has had previous treatment including radiation and/or chemotherapy due to impaired healing. - Blood Clots
Patients who undergo major surgeries, especially patients who have cancer, are at an increased risk of developing blood clots in their legs (deep venous thrombosis or DVT). Sometimes these blood clots can travel through the veins and into the lungs, causing a pulmonary embolism (PE). If such a problem occurs, patients will likely require anticoagulation (blood-thinning) medication to prevent more clots from forming and ending up in their lungs.
Recovery & Aftercare
When you wake up after surgery, you may have a tracheotomy tube, a permanent tracheal stoma (if you underwent a laryngopharyngectomy), and/or a feeding tube, depending on the extent of the surgery and reconstruction. The drain(s) placed during surgery to remove excess fluid and secondarily prevent infection will be taken out a few days following surgery by the surgical team. This is often painless and can be done in a matter of seconds.
Your recovery process may involve physical therapy or speech and swallowing therapy. Once the head and neck surgery team is confident you are ready to be discharged, a discharge planning team will work with you and your family to determine the best route forward.
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