Share This Article:

Upper mediastinal and paratracheal node dissection in total (pharyngo) laryngectomy, it is really indicated?

Abstract Full-Text HTML Download Download as PDF (Size:94KB) PP. 185-188
DOI: 10.4236/ojst.2011.14028    4,468 Downloads   7,186 Views  

ABSTRACT

Introduction: Advanced laryngeal and hypopharyn- geal cancers are aggressive tumors with a poor prog- nosis. Multiple lymph node metastases often occur in the neck as well as in the upper mediastinum and thus upper mediastinal dissection is crucial to im- proving the cure rate. However, excessive mediastinal dissection can increase postoperative morbidity and mortality making it important to employ the proper technique and appropriate extent of dissection. In the present study, we aimed to determine the need and the prognostic importance of mediastinal dissection in patients with advanced carcinoma of the upper aerodigestive tract. Methods: A retrospective review of the records of 30 patients who underwent (phar- ynxgo) laryngectomy for advanced squamous cell carcinomas was done. 17 patients had laryngeal car- cinomas, 13 had hypopharyngeal carcinomas. The mediastinal dissection was designed to remove mainly the paratracheal and retrooesophageal lymph nodes. Results: 60 neck dissections and 30 mediastinal dis- section were performed in 30 patients and yielded positive nodes were found in 20/30 patients. Neck nodes were positive in 9/17 of the patients with la-ryngeal cancer and 11/13 of the patients with hypo- pharyngeal cancers respectively. Positive nodes were detected in the neck regardless of T stage. The medi- astinal nodes were positive in 0% of the patients with laryngeal cancer. Upper mediastinal metastases were detected positive in 6/13 of the hypopharyngeal pa-tients. In these patients, mediastinal metastases were associated with tumors greater than 35 mm. The ma- jority of positive paratracheal nodes were less than 1 cm in diameter and appeared negative preoperatively. 0% of the patients had positive paratracheal nodes alone in a histologically negative cervical neck dissec-tion Regarding the appropriate extent of dissection, no major complications were observed. Conclusions: There is little controversy about neck dissection in advanced tumors of the (pharyngo) larynx. Laryn- geal carcinomas showed no positive mediastinal no- des in this series. The study highlighted the propen- sity of advanced hypopharyngeal cancers to involve the paratracheal nodes.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Dequanter, D. , Shahla, M. , Paulus, P. and Lothaire, P. (2011) Upper mediastinal and paratracheal node dissection in total (pharyngo) laryngectomy, it is really indicated?. Open Journal of Stomatology, 1, 185-188. doi: 10.4236/ojst.2011.14028.

References

[1] Hoffman, H.T., Karnell, L.H., Funk, G.F., Robinson, R.A. and Menck, H.R. (1998) The National Cancer Data Base Report on cancer of the head and neck. Archives of Otolaryngology-Head & Neck Surgery, 124, 951-962.
[2] Ho, C.M., Lam, K.H., Wei, W.I., Yuen, P.W., Lam, L.K. (1993) Squamous cell carcinoma of the hypopharynx— Analysis of treatment results. Head Neck, 15, 405-412. doi:10.1002/hed.2880150507
[3] Lefebvre, J.L., Castelain, B., DeLatorre, J.C., Delobelle- Deroide, A. and Vankemmel, B. (1987) Lymph node invasion in hypopharynx and lateral epilarynx: A prognostic factor. Head & Neck Surgery, 10, 14-18. doi:10.1002/hed.2890100104
[4] Wei, W.I. (2002) The dilemma of treating hypopharyngeal carcinoma: More or less. Archives of Otolaryngology-Head & Neck Surgery, 128, 229-232.
[5] Buckley, J.G. and Lemman, K. (2000) Cervical node metastases in laryngeal and hypopharyngeal cancer: A prospective analysis of prevalence and distribution. Head Neck, 22, 280-385. doi:10.1002/1097-0347(200007)22:4<380::AID-HED11>3.0.CO;2-E
[6] Harris, H.H. and Butler, E. (1968) Surgical limits in cancer of the subglottic larynx. Archives of Otolaryngology, 87, 64-67.
[7] Weber, R.S., Marvel, J., Smith, P., Hankins, P., Wolf, P. and Goepfert, H. (1993) Paratracheal lymph node dissection for carcinoma of the larynx, hypopharynx and cervical esophagus. Archives of Otolaryngology-Head & Neck Surgery, 108, 11-17.
[8] Driscoll, W.G., Nagorsky, M.J., Cantrell, R.W. and Johns, M.E. (1983) Carcinoma of the pyriform sinus: Analysis of 102 cases. Laryngoscope, 93, 556-560.
[9] Bataini, J.P., Bernier, J., Brugere, J., Jaulerry, C., Picco, C. and Brunin, F. (1985) Natural history of neck diseases in patients with squamous cell carcinoma of oropharynx and pharyngolarynx. Radiotherapy & Oncology, 21, 245-255. doi:10.1016/S0167-8140(85)80033-5
[10] Lindberg, R. (1972) Distribution of cervical lymph nodes metastases from squamous cell carcinoma of the upper respiratory and digestive tracts. Cancer, 29, 1446-1449. doi:10.1002/1097-0142(197206)29:6<1446::AID-CNCR2820290604>3.0.CO;2-C
[11] Welsh, L.W. (1964) The normal human laryngeal lymphatics. Annals of Otology, Rhinology, and Laryngology, 73, 569-582.
[12] Harrison, D.F.N. (1975) Laryngectomy for subglottic lesions. Laryngoscope, 85, 1208-1210. doi:10.1288/00005537-197507000-00012
[13] Timon, C.V., Toner, M. and Conlon, B.J. (2003) Paratracheal lymph node involvement in advanced cancer of the larynx, hypopharynx and cervical esophagus. Laryngoscope, 113, 1595-1599. doi:10.1097/00005537-200309000-00035

  
comments powered by Disqus

Copyright © 2018 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.