TITLE:
Upper mediastinal and paratracheal node dissection in total (pharyngo) laryngectomy, it is really indicated?
AUTHORS:
Didier Dequanter, M. Shahla, P. Paulus, P. Lothaire
KEYWORDS:
Advanced Head and Neck Cancer; Mediastinal Dissection; Hypopharynx
JOURNAL NAME:
Open Journal of Stomatology,
Vol.1 No.4,
December
7,
2011
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.