Introduction: Pre-operative endoscopic assessment of the distal extension of hypopharyngeal cancer is essential for proper surgical extirpation. This assessment is frequently not feasible in advanced, obstructing tumours.

Aims: To study the role of a proposed new diagnostic technique: intra-operative open oesophagoscopy, in distal assessment of advanced hypopharyngeal cancer.

Materials and methods: A clinicopathological study, including 35 consecutive patients with obstructing hypopharyngeal cancer.

Results: Intra-operative open oesophagoscopy revealed inferior submucosal tumour extension in 19 out of 22 cases proven histopathologically, with a sensitivity, specificity and accuracy of 86, 100 and 91 per cent, respectively. Oesophageal skip lesions were detected in two cases. Intra-operative open oesophagoscopy findings surpassed data obtained from pre-operative radiological investigations and influenced the extent of resection performed. Accordingly, 19 patients had a total laryngopharyngectomy for local disease control, while 16 patients needed an additional total oesophagectomy. Histopathologically negative inferior resection margins were obtained in all cases.

Conclusions: Intra-operative open oesophagoscopy was found to be a reliable diagnostic modality for distal assessment of obstructing hypopharyngeal cancer in cases in which pre-operative distal endoscopic examination was not feasible.