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Prasad A, Carey RM, Panara K, Rajasekaran K, Cannady SB, Newman JG, Brant JA, Brody RM. Nodal metastasis in surgically treated laryngeal squamous cell carcinoma. Head Neck 2023; 45:2303-2312. [PMID: 37403903 DOI: 10.1002/hed.27437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/02/2023] [Accepted: 06/09/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Management of the neck in laryngeal squamous cell carcinoma (LSCC) is essential to oncologic control and survival. We aim to describe patterns and rates of clinical/pathologic lymph node disease, elective neck dissection (END), and occult lymph node metastasis (LNM) in patients with surgically-managed LSCC. METHODS Retrospective cohort study of patients in the National Cancer Database (NCDB) diagnosed with LSCC between January 2004 and December 2016 who underwent primary surgery. RESULTS Seven thousand eight hundred and seventy-six patients met inclusion criteria. For cN0 patients, the rates of END and occult LNM both increased with tumor stage and were highest for supraglottic tumors. Predictors of occult LNM included supraglottic site, pathologic T3 and T4 stage, positive margins, and presence of lymphovascular invasion (p < 0.05). CONCLUSIONS The propensity for cervical LNM in surgically-managed LSCC varies based on primary tumor site and stage, and a variety of disease factors increase risk of occult LNM.
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Affiliation(s)
- Aman Prasad
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan M Carey
- Department of Otolaryngology-Head & Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Kush Panara
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Steven B Cannady
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jason G Newman
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jason A Brant
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert M Brody
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Poonia SK, Nicolli E. Surgical Management of Advanced Glottic Cancer. Otolaryngol Clin North Am 2023; 56:275-283. [PMID: 37030940 DOI: 10.1016/j.otc.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2023]
Abstract
In advanced glottic cancer, it is widely known that definitive chemoradiation can result in comparable survival outcomes to primary surgery. This deserves consideration given the immense effects total laryngectomy (TL) has on patients. It is important to consider that not all advanced glottic tumors should be treated in the same way, and surgical management remains a critical consideration for optimization of local control and survival outcomes. Advances in organ preservation surgery and the more developed understanding of the survival benefits of TL in extensive T4 disease further support the importance of surgery in the management of advanced glottic cancer.
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Affiliation(s)
- Seerat K Poonia
- Department of Otolaryngology - Head and Neck Surgery, Miller School of Medicine, University of Miami Hospital, 1121 NW 14th Street, Sylvester Medical Office Building, 3rd Floor, Suite 325 Miami, FL 33136, USA
| | - Elizabeth Nicolli
- Department of Otolaryngology - Head and Neck Surgery, Miller School of Medicine, University of Miami Hospital, 1121 NW 14th Street, Sylvester Medical Office Building, 3rd Floor, Suite 325 Miami, FL 33136, USA.
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Abstract
Since the first total laryngectomy was performed in the late 18th century, several improvements and variations in surgical techniques have been proposed for this procedure. The surgical techniques employed in total laryngectomy have not been comprehensively discussed to date. Thus, the main objective of this article was to address controversial aspects related to this procedure and compare different surgical techniques used for a total laryngectomy procedure from the beginning to the end. Although the management paradigms in laryngeal and hypopharyngeal squamous cell carcinomas have shifted to organ-preserving chemoradiotherapy protocols, total laryngectomy still plays a prominent role in the treatment of advanced and recurrent tumors. The increased incidence of complications associated with salvage total laryngectomy has driven efforts to improve the surgical techniques in various aspects of the operation. Loss of voice and impaired swallowing are the most difficult challenges to be overcome in laryngectomies, and the introduction of tracheoesophageal voice prostheses has made an enormous difference in postoperative rehabilitation and quality of life. Advancements in reconstruction techniques, tumor control, and metastatic management, such as prophylactic neck treatments and paratracheal nodal dissection (PTND), as well as the use of thyroid gland-preserving total laryngectomy in selected patients have all led to the increasing success of modern total laryngectomy. Several conclusions regarding the benchmarking of surgical techniques cannot be drawn. Issues regarding total laryngectomy are still open for discussion, and the technique will continue to require improvement in the near future.
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Affiliation(s)
- Adit Chotipanich
- Otolaryngology Department, Chonburi Cancer Hospital, Ministry of Public Health, Chonburi, THA
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Surgical nodal management in hypopharyngeal and laryngeal cancer. Eur Arch Otorhinolaryngol 2020; 277:1481-1489. [PMID: 32048029 PMCID: PMC7160213 DOI: 10.1007/s00405-020-05838-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 01/30/2020] [Indexed: 12/14/2022]
Abstract
Objective The aim of this study is to compare pre-therapeutic staging of the loco-regional lymphatic basin and subsequent surgical management in cN0 versus cN+ hypopharyngeal and laryngeal cancer patients. Methods We analyzed all hypopharyngeal and laryngeal carcinoma patients treated surgically at a single quaternary medical care and cancer center between 2004 and 2014. We established two groups for patients who underwent neck dissection comparing patients with a low LNR (lymph node ratio) to one with a high LNR. Regarding the cN0 cohort, elective neck dissection was evaluated as a secondary predictor variable. Comorbidities, such as anemia and renal insufficiency, were analyzed as potentially influencing disease-free (DFS) and overall survival (OS). Results A total of 310 patients (185 glottic and 125 supraglottic/hypopharyngeal carcinoma) were included. Pre-therapeutic neck MRI-/CT-scan and concomitant neck ultrasound revealed cN+ status in 144 patients resulting in a significant over-staging in 63 patients (44%) who were rated as being pN0 after histological examination. 166 patients were staged cN0 and 21 underwent elective neck dissection (11 local advanced glottic and 10 supraglottic/hypopharyngeal carcinoma). Two cN0 patients showed occult cervical lymph node metastases (10%). Furthermore, we could detect a significant negative impact of the LNR divided by the number of dissected lymph nodes and OS. Conclusion The pre-therapeutic clinical evaluation of lymphatic outgrowth is over-staged. OS decreases with increasing LNR divided by the number of dissected lymph nodes. Renal insufficiency and anemia are significant negative factors, decreasing both OS and DFS.
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Gupta DK, Chugh R, Singh SK, Pati S. Use of the facial artery-based cutaneous island flap (melo-labial flap) for reconstruction of the neopharynx following total laryngectomy: a novel technique. BMJ Case Rep 2019; 12:12/8/e230712. [PMID: 31383687 DOI: 10.1136/bcr-2019-230712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Reconstruction of neopharynx after total laryngectomy is a challenging task. Various locoregional flaps like pectoralis major myocutaneos/ latismus dorsi flaps and free flaps have their own limitations and advantages. To overcome this, we used facial artery-based cutaneous island flap (melo-labial flap) for reconstruction of the neopharynx following total laryngectomy (DK Gupta technique). This flap is thin, pliable, without any gravitational pull and without any risk of anastomosis failure and hence has advantage of both locoregional and free flaps and eliminates the limitations of both. It is simple, reproducible and reliable reconstructive option for neopharynx. We present a case report, review of literature and this novel technique for an excellent outcome and recommend to use it as the new workhorse of neopharyngeal reconstruction.
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Affiliation(s)
| | - Rajeev Chugh
- ENT-HNS, Army Hospital Research and Referral, New Delhi, India
| | | | - Seema Pati
- ENT-HNS, Army Hospital Research and Referral, New Delhi, India
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Abstract
Successful management of laryngeal cancer depends on careful pretreatment evaluation of patient and disease factors to arrive at accurate staging, leading to appropriate treatment selection for patients with this highly impacting disease. Surgical modalities, including transoral laser microsurgery, open partial laryngectomy, and total laryngectomy, offer options, alone or in combination with radiation and chemotherapy. Treatment strategy for laryngeal cancer should strive for cure while maintaining the best quality of life possible for the patient. Achieving the goals of initial and salvage treatment for laryngeal cancer depends on executing a plan of care determined by the expertise of the multidisciplinary team.
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Spriano G, Mercante G, Anelli A, Cristalli G, Ferreli F. Lateral cervical approach for open laryngeal surgery: Technical notes. Head Neck 2019; 41:813-820. [PMID: 30597655 DOI: 10.1002/hed.25475] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/27/2018] [Accepted: 07/19/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Transoral minimally invasive techniques for laryngeal cancer have been proposed to preserve healthy tissues. The aim of this study was to describe a minimally invasive procedure for all laryngectomies with/without neck dissection using a lateral cervical approach. METHODS A monolateral or bilateral neck incision at the level of the anterior border of the sterno-cleido-mastoid muscle is performed in accordance with the side of the neck dissection. The harvesting of an anterior myocutaneous (AMC) cervical flap, including skin, platysma, fascia superficialis, anterior jugular veins, homohyoid and sternohyoid muscles is performed. A neck dissection is executed through the same skin incision. Contraindication is represented by extralaryngeal spread with the involvement of the strap muscles. Supra-hyoid, sternohyoid, and homohyoid muscles and hyoid bone are preserved. CONCLUSION Open partial/total laryngectomies through a lateral cervical approach are feasible and safe. This surgical access with an AMS cervical flap allows to simultaneously perform neck dissections and the removal of the entire laryngeal specimen.
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Affiliation(s)
- Giuseppe Spriano
- Department of Otolaryngology Head and Neck Surgery Humanitas Clinical and Research Hospital, IRCCS Humanitas University, Milan, Italy
| | - Giuseppe Mercante
- Department of Otolaryngology-Head & Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Andrea Anelli
- Department of Otolaryngology-Head & Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giovanni Cristalli
- Department of Otolaryngology-Head & Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Fabio Ferreli
- Department of Otolaryngology Head and Neck Surgery Humanitas Clinical and Research Hospital, IRCCS Humanitas University, Milan, Italy
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D'Souza AM, Mark J, Demarcantonio M, Leino D, Sisson R, Geller JI. Pediatric laryngeal carcinoma in a heterozygous carrier of Fanconi anemia. Pediatr Blood Cancer 2017; 64. [PMID: 28139070 DOI: 10.1002/pbc.26463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 11/14/2016] [Accepted: 12/09/2016] [Indexed: 11/10/2022]
Abstract
A case of invasive, keratinizing squamous cell carcinoma of the larynx in an 8-year-old female treated with laryngectomy is presented. Perinatal exposure to human papilloma virus and constitutional heterozygosity for a FANCC mutation were identified, though FANCC heterozygosity is not known to be cancer predisposing. An additional tumor-associated mutation in NOTCH1 was also identified potentially contributing to oncogenesis. This case illustrates an exceedingly rare type of cancer in the pediatric population and discusses diagnostic workup, evaluation of risk factors for head and neck cancer, and treatment options.
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Affiliation(s)
- A M D'Souza
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - J Mark
- Department of Otolaryngology, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - M Demarcantonio
- Department of Otolaryngology, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - D Leino
- Department of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - R Sisson
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - J I Geller
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Spriano G, Mercante G, Pellini R, Ferreli F. Total laryngectomy: A new lateral cervical approach. Clin Otolaryngol 2017. [PMID: 28635071 DOI: 10.1111/coa.12920] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- G Spriano
- Department of Otolaryngology - Head & Neck Surgery, Regina Elena National Cancer Institute, Rome, Italy
| | - G Mercante
- Department of Otolaryngology - Head & Neck Surgery, Regina Elena National Cancer Institute, Rome, Italy
| | - R Pellini
- Department of Otolaryngology - Head & Neck Surgery, Regina Elena National Cancer Institute, Rome, Italy
| | - F Ferreli
- Department of Otolaryngology - Head & Neck Surgery, Regina Elena National Cancer Institute, Rome, Italy
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Day AT, Sinha P, Nussenbaum B, Kallogjeri D, Haughey BH. Management of primary T1-T4 glottic squamous cell carcinoma by transoral laser microsurgery. Laryngoscope 2016; 127:597-604. [PMID: 27578610 DOI: 10.1002/lary.26207] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/15/2016] [Accepted: 06/27/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVES/HYPOTHESIS Evaluate the oncologic outcomes of patients with early and select advanced primary glottic squamous cell carcinoma (SCCa) managed by transoral laser microsurgery (TLM). STUDY DESIGN Retrospective cohort study. METHODS Ninety cases of TLM-managed primary glottic SCCa were identified retrospectively using a prospectively collected database. RESULTS Outcomes of patients with pTis-pT2a disease (n = 65) and pT2b-pT4a disease (n = 25) were, respectively: 5-year local control, 86.2% and 67.5%; 5-year disease-free survival, 64.9% and 44.9%; 5-year disease-specific survival, 96.4% and 59.0%; laryngeal preservation, 96.9% and 80%. Five of nine patients (56%) with supraglottic-glottic-subglottic tumors were local recurrence-free compared to the 70 of 81 (86%) patients with glottic, supraglottic-glottic, and glottic-subglottic tumors. Seven of 13 patients (54%) with positive or indeterminate margins were local recurrence-free compared to 68 of 77 (88%) patients with negative margins. CONCLUSIONS Given sample size considerations, this study highlights the satisfactory oncologic outcomes of TLM-treated glottic cancer and the potential importance of margin management and disease extension within the larynx. LEVEL OF EVIDENCE 4 Laryngoscope, 127:597-604, 2017.
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Affiliation(s)
- Andrew T Day
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Parul Sinha
- Department of Otolaryngology-Head and Neck Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, U.S.A
| | - Brian Nussenbaum
- Department of Otolaryngology-Head and Neck Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, U.S.A
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, U.S.A
| | - Bruce H Haughey
- Department of Head and Neck Surgery, Florida Hospital Celebration Health, Celebration, Florida, U.S.A.,Department of Surgery, University of Auckland, Auckland, New Zealand
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Surgical treatment of glottic cancer: retrospective analysis of 192 cases in a multidisciplinary tertiary care centre in Pune, India. The Journal of Laryngology & Otology 2015; 129:261-6. [PMID: 25684557 DOI: 10.1017/s0022215115000274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES A multidisciplinary team approach is required for the preservation of voice and appropriate management of glottic cancer. This study aimed to investigate the outcomes of surgically treated glottic cancers of all stages. All aspects of surgical management, such as laser cordectomy, partial laryngectomy, total laryngectomy with voice prosthesis, and salvage laryngectomy, conducted at a single tertiary care institute in India, were reviewed. METHOD A retrospective analysis of hospital records was performed for 192 glottic cancer patients who were surgically treated between 2003 and 2007. RESULTS Patients with tumour stages 1 or 2 glottic cancer treated with laser cordectomy had a local control rate of 85 per cent and five-year survival rate of 98.6 per cent. The findings suggest that the number of partial laryngectomies performed for stage 3 tumours is declining. Patients with a tumour stage 3 lesion with a fixed hemilarynx or a tumour stage 4 lesion, treated with total laryngectomy, were found to have a five-year survival rate of 61.6 per cent. Nodal status was significantly associated with five-year survival rate. CONCLUSION Surgery offers a viable five-year survival rate in glottic cancer patients.
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Lymph node ratio is of limited value for the decision-making process in the treatment of patients with laryngeal cancer. Eur Arch Otorhinolaryngol 2014; 272:453-61. [PMID: 24643852 DOI: 10.1007/s00405-014-2997-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 03/03/2014] [Indexed: 12/29/2022]
Abstract
The lymph node ratio (LNR) combines two types of information--about the extent of neck dissection and about the extent of the pathological examination of the specimen--and thus represents an interesting variable for risk assessment in patients with head and neck cancer. This retrospective study with data from January 1, 1980, to December 31, 2010, evaluates the utility of the LNR as a potential prognostic predictor in patients with laryngeal squamous cell carcinoma (LSCC). A total of 202 consecutive patients with regionally metastasized LSCC who underwent primary surgery with or without adjuvant treatment were included. The mean follow-up period was 4.4 years. The LNR was calculated as the ratio of positive nodes to the total number of nodes removed during neck dissection. Multivariate analysis was carried out. Peak values as averaged clusters of individual LNRs were registered at three points (LNR 0.05, 0.07, and 0.09). LNR 0.09 was a significant prognostic parameter in the Cox regression model (P = 0.007). Patients with an LNR > 0.09 had a hazard ratio of 2.065 for a disease-specific survival event in comparison with LNR < 0.09. The most accurate LNR for LSCC is expected to be located in the range of 0.08-0.1. The LNR seems to be of limited value for the decision-making process in the treatment of patients with LSCC, in comparison with other locations. Prospective trials will be required in order to allow evidence-based recommendations for treatment decisions based on the LNR.
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Chone CT, Kohler HF, Magalhães R, Navarro M, Altemani A, Crespo AN. Levels II and III neck dissection for larynx cancer with N0 neck. Braz J Otorhinolaryngol 2013; 78:59-63. [PMID: 23108821 PMCID: PMC9450695 DOI: 10.5935/1808-8694.20120009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 06/07/2012] [Indexed: 11/21/2022] Open
Abstract
The removal of level II, III, and IV metastases has gained importance in the treatment of squamous cell carcinomas (SCC) of the neck and larynx. This study assessed the possibility of removing level II and level III metastases only, given the low likelihood of occurrence of metastatic lymph nodes on level IV in SCCs of the larynx. Objective This study aimed to analyze the prevalence rates of metastatic lymph nodes on level IV in laryngeal SCC patients. Methods This prospective study enrolled consecutive patients with laryngeal SCC submitted to neck lymph node dissection. Neck levels were identified and marked for future histopathology testing. Results Six percent (3/54) of the necks had level IV metastatic lymph nodes. All cN0 necks (42) were free from level IV metastasis. Histopathology testing done in the cN (+) necks (12) revealed that 25% of the level IV specimens were positive for SCC. The difference between cN0 and cN (+) necks was statistically significant (p = 0.009). Level IV metastases never occurred in isolation, and were always associated with level II or level III involvement (p = 0.002). Conclusion The prevalence rate for lymph node metastasis in cN0 necks was 0%. Level IV metastatic lymph nodes were correlated to cN (+) necks. Level IV metastasis was associated with the presence of metastatic lymph nodes in levels II or III.
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Is elective neck dissection necessary for the surgical management of T2N0 glottic carcinoma? Auris Nasus Larynx 2013; 40:85-8. [DOI: 10.1016/j.anl.2011.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 11/14/2011] [Accepted: 12/06/2011] [Indexed: 11/23/2022]
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Afectación ganglionar en el cáncer de laringe y actitud terapéutica. Semergen 2012; 38:491-7. [DOI: 10.1016/j.semerg.2011.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 12/15/2011] [Indexed: 11/20/2022]
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Prognostic Significance of Nodal Metastasis in Advanced Tumours of the Larynx and Hypopharynx. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.otoeng.2012.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Barroso Ribeiro R, Ribeiro Breda E, Fernandes Monteiro E. Prognostic significance of nodal metastasis in advanced tumors of the larynx and hypopharynx. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2012; 63:292-8. [PMID: 22579383 DOI: 10.1016/j.otorri.2012.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Revised: 02/06/2012] [Accepted: 02/13/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To estimate the relevance of post-surgical neck nodal classification (pN) on the global survival of patients with advanced tumors of the larynx and hypopharynx, primarily treated with surgery including neck dissection (ND). To understand the prognostic significance of metastatic lymph nodes' extracapsular spread (ECS) and its impact on survival. MATERIAL AND METHODS A retrospective review of patients primarily submitted for total laryngectomy (TL) with either elective or therapeutic bilateral ND. Overall and disease-free survival was analysed according to post-operative histopathological ND results, concerning the presence or absence of nodal involvement, number of affected nodes and the existence of ECS. RESULTS One hundred and twenty patients met the inclusion criteria of this study. Concerning nodal involvement, the histopathological evaluation demonstrated positive lymph nodes in 46.6% of the cN0 patients. The rate of patients alive after 2 years of follow-up, based on pN analysis, was 88.1% for the pN0 group, 65.4% for the group N+ without ECS, 46.2% for the N+ ECS+ (1 node) and 15.4% for the N+ ECS+ (more than 1 node) group (P<.001). CONCLUSIONS This study demonstrates a high prevalence of occult neck disease in tumours of the larynx and hypopharynx. The involvement of metastatic cervical lymph nodes has a negative impact on survival. Patients with multinodal ECS have a poorer survival, reflected by a higher rate of loco-regional and distant metastases, when compared to ECS in one single lymph node.
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Affiliation(s)
- Ricardo Barroso Ribeiro
- Departamento de Otorrinolaringología, Instituto Oncológico Portugués Francisco Gentil, Oporto, Portugal.
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Paratracheal lymph node dissection does not negatively affect thyroid dysfunction in patients undergoing laryngectomy. Eur Arch Otorhinolaryngol 2009; 267:807-10. [DOI: 10.1007/s00405-009-1152-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 10/26/2009] [Indexed: 10/20/2022]
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Bussu F, Almadori G, De Corso E, Rizzo D, Rigante M, Parrilla C, Valentini V, Paludetti G. Endoscopic horizontal partial laryngectomy by CO(2) laser in the management of supraglottic squamous cell carcinoma. Head Neck 2009; 31:1196-206. [PMID: 19360749 DOI: 10.1002/hed.21085] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The objective of this study was to evaluate the results of endoscopic horizontal supraglottic laryngectomy (EHSL) by CO(2) laser. METHODS Between 1996 and 2005, 78 patients underwent a horizontal supraglottic laryngectomy operation (HSL) with an external approach and 70 underwent laser EHSL, as treatment for supraglottic laryngeal squamous cell carcinoma (LSCC). We evaluated oncological endpoints, comparing the external and the endoscopic approach. RESULTS Among patients primarily treated by EHSL, the 5-year disease-specific survival (DSS) was 89% (vs 80% in the external approach group). Statistical analysis did not reveal significant differences between the 2 groups as for survival nor for organ preservation. The most significant clinical predictor for DSS is neck relapse (p < .0001). CONCLUSIONS This study confirms the effectiveness of laser EHSL in which oncological outcome is similar to the external approach and functional results are probably better. Neck management in this setting is fundamental to warrant the best survival.
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Affiliation(s)
- Francesco Bussu
- Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Rome, Italy.
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Pennings RJE, Marres HAM, den Heeten A, van den Hoogen FJA. Efficacy of diagnostic upper node evaluation during (salvage) laryngectomy for supraglottic carcinoma. Head Neck 2009; 31:158-66. [DOI: 10.1002/hed.20948] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Ferlito A, Silver CE, Rinaldo A. Elective management of the neck in oral cavity squamous carcinoma: current concepts supported by prospective studies. Br J Oral Maxillofac Surg 2009; 47:5-9. [PMID: 19121878 DOI: 10.1016/j.bjoms.2008.06.001] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Accepted: 06/02/2008] [Indexed: 11/18/2022]
Abstract
The incidence of occult cervical metastasis in oral cavity cancer, even in early stages, is significant, necessitating elective treatment of the neck in a majority of cases. There is no method of imaging or other examination that will detect microscopic foci of metastatic disease in cervical lymph nodes. Immunohistochemical and molecular analysis of neck specimens reveals the incidence of occult metastases to be higher than revealed by light microscopy with ordinary hematoxylin and eosin staining. The neck may be treated electively by surgery or irradiation. Surgery has the advantage of permitting pathological staging of the neck, avoiding unnecessary radiation treatment and indicating cases where adjuvant therapy should be employed. As oral cavity cancer rarely metastasizes to level V, a radical or modified radical neck dissection of all five node levels is not necessary. Selective dissection of levels I-III ("supraomohyoid neck dissection") is the usual procedure of choice for elective dissection of the neck. Most of the relatively small number of isolated metastasis to level IV are from primary tumours of the tongue, which are known to produce "skip" metastases. Thus an "extended supraomohyoid neck dissection" of levels I-IV is recommended by some authors for elective treatment of the neck in tongue cancer. A number of recent prospective multi-institutional studies have demonstrated that sublevel IIB is rarely involved with isolated metastasis from oral cavity primary tumours, except from some tongue cancers. Thus it is justifiable to omit dissection of sublevel IIB in elective treatment of most cases of oral cavity cancer. Bilateral neck dissection should be performed in elective treatment of tumours involving midline structures, and in patients with ipsilateral neck metastasis.
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Affiliation(s)
- Alfio Ferlito
- Department of Surgical Sciences, ENT Clinic, University of Udine, Udine, Italy
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Neck Dissection for Laryngeal Cancer. J Am Coll Surg 2008; 207:587-93. [DOI: 10.1016/j.jamcollsurg.2008.06.337] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Revised: 06/23/2008] [Accepted: 06/23/2008] [Indexed: 11/22/2022]
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Efficacy of diagnostic upper-node procedures during laryngectomy for glottic carcinoma. Am J Surg 2008; 197:666-73. [PMID: 18778803 DOI: 10.1016/j.amjsurg.2008.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2007] [Revised: 03/09/2008] [Accepted: 03/09/2008] [Indexed: 11/21/2022]
Abstract
BACKGROUND Regional recurrence of glottic squamous cell carcinoma was evaluated in patients with a clinically N0 neck who underwent selective upper-node dissection (SUND) or selective upper-node inspection (SUNI; surgical visualization and palpation of jugular lymph nodes at levels II and III) during (salvage) laryngectomy. METHODS In 152 patients, 291 clinically N0 (139 bilateral and 13 contralateral) necks were evaluated for occult neck metastases by SUNI or SUND during (salvage) laryngectomy. RESULTS Occult neck metastases were identified with SUNI or SUND in 7% of the necks (21 of 291). In 4% (n = 11) of the remaining 270 necks, regional recurrence was detected during follow-up evaluation. Thus, in these 8 patients, SUNI or SUND seemed to have failed. CONCLUSIONS SUND or SUNI of levels II and III during (salvage) laryngectomy identified the vast majority of patients who needed extensive neck treatment. In the N0 necks, these techniques led to less morbidity than elective neck dissection.
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Selective Neck Dissection (IIA, III): A Rational Replacement for Complete Functional Neck Dissection in Patients With N0 Supraglottic and Glottic Squamous Carcinoma. Laryngoscope 2008; 118:676-9. [DOI: 10.1097/mlg.0b013e31815f6f25] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Antonio JK, Menezes MB, Kavabata NK, Bertelli AAT, Kikuchi W, Gonçalves AJ. Selective neck dissection for treating node-positive necks in cases of squamous cell carcinoma of the upper aerodigestive tract. SAO PAULO MED J 2008; 126:112-8. [PMID: 18553034 DOI: 10.1590/s1516-31802008000200009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2007] [Accepted: 03/12/2008] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Modified radical neck dissection (MRND) is the classical treatment for neck metastases of squamous cell carcinoma (SCC) of the upper aerodigestive tract. However, it may still be accompanied by significant sequelae. One alternative for this treatment would be selective neck dissection (SND), which has a lower incidence of sequelae. The aim of this study was to define which neck metastasis cases would really be suitable candidates for SND. DESIGN AND SETTING Retrospective clinical-surgical trial at the Division of Head and Neck Surgery, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP). METHODS We retrospectively studied 67 patients with SCC of the upper aerodigestive tract, divided into two groups: 1) 47 patients treated by means of SND (node-negative or node-positive), 2) 20 patients treated by means of MRND (all node-positive). RESULTS Our results demonstrated that there was no difference between the patients treated with SND or MRND in relation to disease evolution, and that the main prognostic factor was lymph node involvement. We observed that patients with pharyngeal SCC and older patients presented worse evolution and would probably not be suitable candidates for SND. CONCLUSIONS SND may be a good option for treating node-positive necks in selected cases.
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Affiliation(s)
- Jamile Karina Antonio
- Division of Head and Neck Surgery, Department of Surgery, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, Brazil
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Tao L, Lefèvre M, Ricci S, Saintigny P, Callard P, Périé S, Lacave R, Bernaudin JF, Lacau St Guily J. Detection of occult carcinomatous diffusion in lymph nodes from head and neck squamous cell carcinoma using real-time RT-PCR detection of cytokeratin 19 mRNA. Br J Cancer 2006; 94:1164-9. [PMID: 16622440 PMCID: PMC2361256 DOI: 10.1038/sj.bjc.6603073] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The aim of the present study was to evaluate the occult lymph node carcinomatous diffusion in head and neck squamous cell carcinoma (HNSCC). A total of 1328 lymph nodes from 31 patients treated between 2004 and 2005 were prospectively evaluated by routine haematoxylin–eosin–safran (HES) staining, immunohistochemistry (IHC) and real-time Taqman reverse–transcriptase polymerase chain reaction (real-time RT–PCR) assay. Amplification of cytokeratin 19 (CK19) mRNA transcripts using real-time RT–PCR was used to quantify cervical micrometastatic burden. The cervical lymph node metastatic rates determined by routine HES staining and real-time RT–PCR assay were 16.3 and 36.0%, respectively (P<0.0001). A potential change in the nodal status was observed in 13 (42.0%) of the 31 patients and an atypical pattern of lymphatic spread was identified in four patients (12.9%). Moreover, CK19 mRNA expression values in histologically positive lymph nodes were significantly higher than those observed in histologically negative lymph nodes (P<0.0001). These results indicate that real-time RT–PCR assay for the detection of CK19 mRNA is a sensitive and reliable method for the detection of carcinomatous cells in lymph nodes. This type of method could be used to reassess lymph node status according to occult lymphatic spread in patients with HNSCC.
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Affiliation(s)
- L Tao
- Service d'ORL et Chirurgie Cervico-Faciale, Université Pierre et Marie Curie, Paris VI, Hôpital Tenon APHP, 4 rue de la Chine, Paris 75020, France
- Histologie-Biologie Tumorale, EA 3499 Université Pierre et Marie Curie Paris VI, Hôpital Tenon APHP, Paris 75020, France
- Department of Otolaryngology-HNS, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - M Lefèvre
- Anatomie-Pathologique, EA 3499 Université Pierre et Marie Curie Paris VI, Hôpital Tenon APHP, Paris 75020, France
| | - S Ricci
- Histologie-Biologie Tumorale, EA 3499 Université Pierre et Marie Curie Paris VI, Hôpital Tenon APHP, Paris 75020, France
| | - P Saintigny
- Histologie-Biologie Tumorale, EA 3499 Université Pierre et Marie Curie Paris VI, Hôpital Tenon APHP, Paris 75020, France
| | - P Callard
- Anatomie-Pathologique, EA 3499 Université Pierre et Marie Curie Paris VI, Hôpital Tenon APHP, Paris 75020, France
| | - S Périé
- Service d'ORL et Chirurgie Cervico-Faciale, Université Pierre et Marie Curie, Paris VI, Hôpital Tenon APHP, 4 rue de la Chine, Paris 75020, France
| | - R Lacave
- Histologie-Biologie Tumorale, EA 3499 Université Pierre et Marie Curie Paris VI, Hôpital Tenon APHP, Paris 75020, France
| | - J-F Bernaudin
- Histologie-Biologie Tumorale, EA 3499 Université Pierre et Marie Curie Paris VI, Hôpital Tenon APHP, Paris 75020, France
| | - J Lacau St Guily
- Service d'ORL et Chirurgie Cervico-Faciale, Université Pierre et Marie Curie, Paris VI, Hôpital Tenon APHP, 4 rue de la Chine, Paris 75020, France
- Service d'ORL et Chirurgie Cervico-Faciale, Université Pierre et Marie Curie, Paris VI, Hôpital Tenon APHP, 4 rue de la Chine, Paris 75020, France. E-mail:
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Rinaldo A, Elsheikh MN, Ferlito A, Chone CT, Coskun HH, Köybasiŏglu A, Esclamado RM, Corlette TH, Talmi YP. Prospective studies of neck dissection specimens support preservation of sublevel IIB for laryngeal squamous carcinoma with clinically negative neck. J Am Coll Surg 2006; 202:967-70. [PMID: 16735212 DOI: 10.1016/j.jamcollsurg.2006.02.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Revised: 02/22/2006] [Accepted: 02/24/2006] [Indexed: 10/24/2022]
Affiliation(s)
- Alessandra Rinaldo
- Department of Surgical Sciences, ENT Clinic, University of Udine, Udine, Italy
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Elsheikh MN, Mahfouz ME, Salim EI, Elsheikh EA. Molecular assessment of neck dissections supports preserving level IIB lymph nodes in selective neck dissection for laryngeal squamous cell carcinoma with a clinically negative neck. ORL J Otorhinolaryngol Relat Spec 2006; 68:177-84. [PMID: 16465073 DOI: 10.1159/000091396] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Accepted: 09/09/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVES It was the aim of this study to determine whether level IIB lymph nodes can be saved in elective neck dissection as a treatment for patients with squamous cell carcinoma (SCC) of the larynx. We present a prospective analysis of a case series. METHODS Thirty-one patients with SCC of the larynx and without palpable lymph nodes at the neck who underwent an elective neck dissection were prospectively studied. The incidence of micrometastasis to level IIB lymph nodes after performing elective neck dissection was evaluated by nested reverse transcription polymerase chain reaction for cytokeratin (CK)19 and CK20 as well as by pathological examination. RESULTS Nested reverse transcription polymerase chain reaction for CK19 and CK20 mRNA presented similar results but differed from the pathological examination. Of the 31 patients, 6 (19%) by pathological analysis and 9 (29%) by molecular analysis had lymph nodes positive for metastatic SCC. By molecular analysis, only 1 of the 31 patients had involvement of level IIB lymph nodes. CONCLUSIONS This region may be preserved in elective neck dissection in patients with SCC of the larynx, so that accessory nerve dysfunction can be minimized and operative time can be saved.
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Ferlito A, Rinaldo A, Silver CE, Gourin CG, Shah JP, Clayman GL, Kowalski LP, Shaha AR, Robbins KT, Suárez C, Leemans CR, Ambrosch P, Medina JE, Weber RS, Genden EM, Pellitteri PK, Werner JA, Myers EN. Elective and therapeutic selective neck dissection. Oral Oncol 2006; 42:14-25. [PMID: 15979381 DOI: 10.1016/j.oraloncology.2005.03.009] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2005] [Accepted: 03/20/2005] [Indexed: 11/22/2022]
Abstract
Selective neck dissection is a modification of the more comprehensive modified radical or radical neck dissection that is designed to remove only those nodal levels considered to be at risk for harboring nodal metastases. The role of selective neck dissection continues to evolve: while initially designed as a staging and diagnostic procedure for patients without clinical evidence of nodal disease, a growing body of literature suggests that selective neck dissection has a therapeutic role in patients with clinical and histologic evidence of nodal metastases. The rationale behind selective neck dissection, its application in the clinically negative but histologically node-positive neck and the extended application of selective neck dissection in patients with clinical evidence of nodal disease are discussed.
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Affiliation(s)
- Alfio Ferlito
- Department of Surgical Sciences, ENT Clinic, University of Udine, Policlinico Universitario, Piazzale S. Maria della Misericordia, 33100 Udine, Italy.
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Ferlito A, Rinaldo A. Neck dissection: historical and current concepts. Am J Otolaryngol 2005; 26:289-95. [PMID: 16137525 DOI: 10.1016/j.amjoto.2005.01.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2004] [Indexed: 10/25/2022]
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Jović R, Canji K, Mitrović S, Kljajić V. [Selective neck dissection in the treatment of pN1/2 lymph node metastases in the neck]. ACTA ACUST UNITED AC 2003; 56:221-6. [PMID: 14565043 DOI: 10.2298/mpns0306221j] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION As yet there is no single reliable and accurate method for detection of neck lymph node metastases. Therapeutic approaches differ from one author to other. The aim of this paper was to establish the extent to which, with good control of primary process, we can control spreading of malignant disease by means of selective neck dissection. MATERIAL AND METHOD This retrospective study included 595 surgically treated patients in the period 1990-1998. There were 525 patients with malignant laryngeal tumors, and 70 patients with malignant hypopharyngeal tumors. Preoperative diagnostics of enlarged lymph nodes was based on palpation of the neck, without CT, US, NMR diagnostics. With all risky N0 patients, selective neck dissection was performed for presence of occult metastases. Intraoperative frozen section analysis was not performed. Adjuvant radiatitherapy was performed in all patients in whom presence of neck lymph node metastases was histologically proved. RESULTS Selective lateral neck dissection was performed in 389 (65.4%) patients. In 78 (20%) patients, lymph node metastases were pathohistologically detected. In 5 (6.4%) transitional cellular cancer was histologically diagnosed, and the remaining 73 (93.6%) presented with squamous cell cancer. Postoperative radiation therapy was applied in 54 patients (69.2%) while 24 (30.8%) were not irradiated. 5-year survival was achieved in 18 (23.1%), and 3-year survival was achieved in 15 (19.2%) patients. Out of 45 patients who lived less than tree year, 18 (40%) presented with metastatic relapse and fatal outcome. Relapse of neck metastases appeared in 12 (11.9%) on the side and in the zones of lymph nodes which were included in neck dissection. Recurrence of neck metastases appeared in 8.3% of patients who were not irradiated postoperatively and in 32.1% of cases irradiated postoperatively. DISCUSSION This study includes comparison of our results with results of literature data. CONCLUSION Neck lymph node metastases point to advanced malignant process of the third or forth stage of the disease when results are the worst and 5-year survival decreases with or without adjuvant radiotherapy.
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Affiliation(s)
- Rajko Jović
- Klinika za bolesti uva, grla i nosa, Klinicki centar Novi Sad.
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Ferlito A, Kowalski LP, Silver CE, Shaha AR, Rinaldo A, Byers RM. The use and misuse of level IA dissection for head and neck cancer. Acta Otolaryngol 2002; 122:553-5. [PMID: 12206268 DOI: 10.1080/00016480260092390] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Alfio Ferlito
- Department of Otolaryngology-Head and Neck Surgery, University of Udine, Policlinico Universitario, Italy.
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Ferlito A, Robbins KT, Shaha AR, Pellitteri PK, Kowalski LP, Gavilan J, Silver CE, Rinaldo A, Medina JE, Pitman KT, Byers RM. Current considerations in neck dissection. Acta Otolaryngol 2002; 122:323-9. [PMID: 12030584 DOI: 10.1080/000164802753648259] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Alfio Ferlito
- Department of Otolaryngology--Head and Neck Surgery, University of Udine, Italy.
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Wong RJ, Rinaldo A, Ferlito A, Shah JP. Occult cervical metastasis in head and neck cancer and its impact on therapy. Acta Otolaryngol 2002; 122:107-14. [PMID: 11876589 DOI: 10.1080/00016480252775832] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Richard J Wong
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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Ferlito A, Shaha AR, Gavilán J, Buckley JG, Rinaldo A, Herranz J, Suárez C. Is radiotherapy recommended after supraglottic laryngectomy? Acta Otolaryngol 2001; 121:877-80. [PMID: 11718256 DOI: 10.1080/00016480152602375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- A Ferlito
- Department of Otolaryngology-Head and Neck Surgery, University of Udine, Policlinico Universitario, Italy.
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dos Santos CR, Gonçalves Filho J, Magrin J, Johnson LF, Ferlito A, Kowalski LP. Involvement of level I neck lymph nodes in advanced squamous carcinoma of the larynx. Ann Otol Rhinol Laryngol 2001; 110:982-4. [PMID: 11642434 DOI: 10.1177/000348940111001016] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study was performed to evaluate the incidence of metastasis at level I in patients with squamous laryngeal cancer. One hundred consecutive patients with squamous carcinoma of the larynx were submitted to surgical treatment including radical neck dissection. The tumor stage was T3 or T4, and the neck stage was N1-N2c. Lymph node metastases were pathologically confirmed in 80 patients. Metastases were concentrated within level II in 59% of cases, level III in 17% of cases, level IV in 11% of cases, and level V in 6% of cases. Only 2 patients (2%) had detectable tumors in the lymph nodes of the submandibular triangle (level IB). This study shows that patients with laryngeal cancer rarely present metastases at the submandibular triangle, even in advanced local disease with cervical metastasis staged as N1 to N2c. Therefore, dissection of the submandibular triangle is indicated only in the presence of clinical, radiographic, or cytologic evidence of metastatic disease at level I.
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Affiliation(s)
- C R dos Santos
- Department of Otorhinolaryngology-Head and Neck Surgery, Center for Treatment and Research, A. C. Camargo Cancer Hospital, São Paulo, Brazil
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Affiliation(s)
- A Ferlito
- Department of Otolaryngology-Head and Neck Surgery, University of Udine, Policlinico Universitario, Italy.
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Ferlito A, Buckley JG, Shaha AR, Silver CE, Rinaldo A, Kowalski L. The role of neck dissection in the treatment of supraglottic laryngeal cancer. Acta Otolaryngol 2001; 121:448-53. [PMID: 11508502 DOI: 10.1080/000164801300366561] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Ferlito A, Rinaldo A. Controversies in the treatment of N(0) neck in laryngeal cancer: neck dissection, no surgery or sentinel lymph node biopsy? ORL J Otorhinolaryngol Relat Spec 2000; 62:287-9. [PMID: 11054009 DOI: 10.1159/000027770] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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