OBJECTIVES/HYPOTHESIS: To address the controversial acceptable distal resection margin for the surgical management of patients with hypopharyngeal cancer. STUDY DESIGN: Retrospective review of the records of 28 consecutive patients who underwent pharyngoesophagectomy and reconstruction with radial forearm free flaps between 1996 to 2001. METHODS: The Kaplan-Meier method was used to estimate survival and recurrence-free time. RESULTS: The minimum follow-up time was 2 years, and there were 14 (50%) patients who had recurrences. Analysis revealed that only one (3%) patient experienced a recurrence at the inferior resection margin, the junction of the free flap reconstruction, and the cervical esophagus. Estimated 4 year survival was 48.5%. CONCLUSIONS: Total laryngopharyngectomy and partial esophagectomy with radial forearm free flap reconstructions in appropriately selected patients with hypopharyngeal cancer does not compromise local recurrence rates at the distal esophageal margin.