Letter to the Editor in Chief regarding the paper entitled “Lateral hypopharyngectomy with laryngeal preservation reconstructed with inlay fascio-cutaneous free flaps: clinical and functional outcomes” by Lancini et al.

To the Editor,

We read with great interest the article “Lateral hypopharyngectomy with laryngeal preservation reconstructed with inlay fascio-cutaneous free flaps: clinical and functional outcomes” by Lancini et al., recently published in Acta Otorhinolaryngologica Italica. The authors provide a commendable contribution to the surgical management of hypopharyngeal squamous cell carcinoma (HSCC) with laryngeal preservation and outline specific tumour-related criteria that must be met for their conservative approach to be feasible, i.e.; 1) unilateral hypopharyngeal lesions centred on the lateral wall of the piriform sinus, without involvement of the retrocricoid region, posterior hypopharyngeal wall, or oesophageal mucosa; 2) preserved arytenoid motility, without invasion of the cricoid and/or thyroid cartilage. We believe that a combined transoral endoscopic approach provides higher precision in delineating the superior, superolateral, and superomedial resection margins of the hypopharynx. This technique enables accurate placement of the pharyngeal opening to the neck from an inside-to-outside perspective, thereby expanding the indications for conservative surgery even when the posterior hypopharyngeal wall is involved or for tumours originating from this region. We are pleased to share our experience with two cases of HSCC affecting the posterolateral and posterior wall of the hypopharynx, which we successfully resected using a combined open and transoral endoscopic technique.