[Therapy of hypopharyngeal cancer. Part III: The concept of minimally invasive therapy of cancers of the upper aerodigestive tract with special reference to hypopharyngeal cancer and trans-oral laser microsurgery].

The concept of minimally invasive therapy in the treatment of tumors of the upper aerodigestive tract is described with special respect to hypopharyngeal carcinomas and transoral laser microsurgery. Differences to conventional surgical treatment regarding operative strategy and technique and resulting advantages are shown. The individual "customized" tailored surgery corresponding to the extent of tumor generally allows maximum preservation of the affected organ and function, even in rather extended tumors. Preconditions for this method are the transoral approach and the possibility of intraoperative evaluation of the true extent of tumor by using the surgical microscope. Incisions through larger tumors enable identification of basal margins and possible infiltration of surrounding structures. The possibility for verifying histologically the margins of resection of the primary tumor is discussed as well as the technical, oncological and functional limits of transoral surgery. The advantage of this method of treatment involves leaving open intra- and postoperatively all diagnostic and therapeutic (surgical) options: i.e., endoscopic re-resections, conventional partial or radical resection and postoperative radiotherapy with or without chemotherapy. The treatment of cervical lymph nodes is usually performed as a selective uni- or bilateral neck dissection (levels II-IV) include functional procedures N0 to N2. The indications for possible adjuvant therapy (radio- and/or chemotherapy) depend on pT- and pN-staging. The prerequisites for successful treatment and our current therapeutic guidelines are described.