Patterns of Cervical Node Metastases From Squamous Carcinoma of the Larynx

Candela, Frank C.; Shah, Jayesh; Jaques, David P.; Shah, Jatin P.

doi:10.1001/archotol.1990.01870040054013

Cited by 168 publications

(124 citation statements)

References 9 publications

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“…Intraoperative examination by frozen section analysis and routine pathological assessment of the sentinel lymph node may fail to detect metastases later revealed by serial sections, or by immunohistochemical or molecular biology assays. In addition, the occurrence of 'skip' metastases, which bypass the first draining lymph node, has been well documented in patients with head and neck cancers, particularly in patients with tumors of the tongue [99], the floor of the mouth [100], and larynx [69,98].…”

Section: Choice Of Surgical Procedures For Elective Treatment Of the Neckmentioning

confidence: 99%

Surgical Treatment of the Neck in Cancer of the Larynx

Ferlito¹,

Silver²,

Rinaldo³

et al. 2000

ORL

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Current concepts in management of the clinically negative and clinically positive neck in laryngeal cancer are reviewed. Occult disease in the neck not detected by physical and radiographic examination may also be difficult to identify on routine histologic examination. Immunohistochemistry or molecular analysis may detect metastatic involvement not apparent by light microscopy. The surgeon should be aware of the relatively high incidence of micrometastases in patients with laryngeal cancer to establish optimal treatment approaches. Elective treatment of the neck is recommended for supraglottic tumors staged T2 or higher, and glottic or subglottic tumors staged T3 or higher.The neck may be treated electively by either surgery or irradiation, but irradiation is best reserved for cases where that modality is employed for the primary tumor. Elective neck dissection provides important information for prognostic purposes and therapeutic decisions, by establishing the presence, number, location and nature of occult lymph node metastases. The selective lateral neck dissection (levels II, III and IV), unilateral or bilateral, is the procedure of choice for elective treatment. Paratracheal nodes (level VI) should be dissected in cases of advanced glottic and subglottic cancer. Complete radical or functional neck dissections are excessive in extent, as levels I and V are almost never involved. Sentinel lymph node biopsy may fail to detect tumor on frozen section examination or may not reveal ‘skip’ metastases.The clinically involved neck is usually treated by complete radical or functional neck dissection of levels I through V. Selective neck dissection has been employed successfully in selected cases, particularly for N1 or occasionally N2 nodal involvement. The selective neck dissection can be extended to include structures at risk. More advanced disease has been treated in this manner often in association with adjuvant chemotherapy and/or irradiation. While the benefit of adjuvant treatment is difficult to assess, it appears most useful in cases with extranodal spread of disease, a factor associated with the worst prognosis.

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Section: Choice Of Surgical Procedures For Elective Treatment Of the Neckmentioning

confidence: 99%

Surgical Treatment of the Neck in Cancer of the Larynx

Ferlito¹,

Silver²,

Rinaldo³

et al. 2000

ORL

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“…3,25,26 Fizik muayene ve görüntüleme yöntemleriyle N0 kabul edilen boyun için bir kısım cerrah derhal elektif boyun diseksiyonu önerirken, diğerleri ise "bekle gör"ü savunurlar. Klinik muayenede pozitif lenf nodu olan vakaların ilk tedavisi sırasında boynun tedavisi zorunludur.…”

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The relationship between the frequency of cervical metastases and tumor related factors in laryngeal cancer and outcome of surgical treatment in these cases

Şengül

Bağlam²,

Çevik³

et al. 2012

J Clin Exp Invest

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Objectives: We aimed to assess the associations between localization, size, stage and histopathological differentiation of primary tumor in larynx and neck metastases and the impact of disease stage on survival. Materials and methods:We analyzed the medical records of 333 laryngeal cancer patients who underwent total or partial laryngectomy as primary treatment, combined with neck dissection and/or postoperative radiotheraphy if required, between 2000 and 2010 years at our clinic. Age and gender of patients, tumor localization, size, stage and histopathological differentiation of tumor; presence of preoperative positive lymph nodes, performed operations, operation findings and histopathological results were analysed retrospectively. Results:Tumor localizations were glottic in 172 (51.6%) cases, supraglottic in 108 (32.4%), and transglottic 53 (15.9%) of the the cases. In glottic cancers; cervical metastases were observed in 18.6% of the patients, whereas occult metastases in 11%. In supraglottic cancers; cervical metastasis rate was 45.3% and occult metastases rate was 24%. In transglottic cancers, cervical metastases rate was 49% and occult metastases was 22.6%. Postoperative recurrence was 41 (12.3%). Postoperative radiotherapy was recommended to 111 of 333 patients. The overall survival rate was 75.4% at 50th month and the cumulative survival rate was 68.9%. Conclusion:In conclusion, although there is controversy regarding the optimal treatment in the N0 larynx cancers, in case of a high risk for occult metastases, elective unilateral or bilateral neck dissection should be performed according to the anatomic localization of the tumor. In addition, survival rate decreased significantly with the increasing tumor stage. J Clin Exp Invest 2012; 3(2): 214-222Key words: Larynx cancer, localization, stage, cervical lymph node metastases, survival ÖZET Amaç: Çalışmamızda larenkste tespit edilen primer tümörün lokalizasyonu, büyüklüğü, evresi, histopatolojik diferansiasyon derecesi, tutmuş olduğu anatomik yapı ile boyun metastazı arasındaki ilişkisi ve tümörün evresinin sağkalım üzerine olan etkisini araştırdık. Gereç ve yöntem:Kliniğimizde 2000-2010 yılları arasında larenks kanseri nedeniyle primer tedavi olarak cerrahi (total veya parsiyel larenjektomi) uygulanmış olan, gerektiğinde boyun diseksiyonu yapılan ve gerektiğinde postoperatif radyoterapi uygulanan 333 hastanın dosyaları incelendi. Hastaların yaşı, cinsiyeti, tümörün lokalizasyonu, tümörün büyük-lüğü, tümörün evresi, histopatolojik diferansiasyon derecesi, preoperatif pozitif lenf nodu bulunup bulunmadığı, yapılan ameliyatlar, ameliyat bulguları ve postop spesmenin histopatolojik değerlendirme sonuçları retrospektif olarak incelendi. Bulgular: Tümörün yerleşim bölgesine göre; vakaların 172'si (%51.6) glottik, 108'i (%32.4) supraglottik, 53'ü (%15.9) ise transglottik yerleşimliydi. Glottik tümörlerde %18.6 oranında servikal metastaz, %11 oranında occult metastaz tespit edilirken, supraglottik tümörlerde %45.3 oranında servikal metastaz, %24 oranında...

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“…8,10,11 Bizim çalışmamızda da en sık servikal metastazın level IIA'ya daha sonra ise sırasıyla Level III, level IV ve level IIB'ye olduğu gözlenmiştir. En az servikal metastazın ise level I ve level V'e olduğu gözlenmiştir.…”

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Larenks kanserli hastalarda servikal metastazların boyundaki seviyelere göre dağılım sıklığı [The frequency of distribution of cervical metastases according to the neck level in patients with larynx cancer]

Şengül¹,

Bağlam²,

Çevik³

et al. 2012

J Clin Exp Invest

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Objectives: In this study we aimed to assess the frequency of distribution for cervical metastases, according to the neck level in patients with larynx cancer who underwent neck dissection. In addition, we also evaluated the safety of selective neck dissection compared to comprehensive neck dissection especially in preoperative N0 patients. Materials and methods:In our experience, to determine the frequency of metastases in each level, the specimen is sent for pathological examination by dividing each level separately after neck dissection. In our study; we retrospectively analysed the medical records of 145 laryngeal cancer patients who were treated with surgery (total or partial laryngectomy) as primary treatment and combined with neck dissection between 2005 and 2010 in our Otolaryngology Department. The patients with the diagnosis of laryngeal cancer who underwent surgery without neck dissection were excluded from the analysis. Results:Level I or level V involvement was not observed in preoperative N0 cases. In cases that had contralateral involvement, there was ipsilateral involvement too and all of these cases were preoperative N+ cases. The classification based on the distribution of levels of 145 cases' cervical metastases revealed that among ipsilateral involvements, 1 (0.6%) was detected at level IA, 32 (22%) at level IIA, 3 (2%) at level IIB, 19 (13%) at level III, 2 (1.3%) at level IV and 1 (1.3%) at level V. When contralateral involvement considered, 13 (8.9%) were detected at level IIA and 1 (0.6%) at level III. Conclusions:The neck specimen findings of 145 laryngeal cancer patients treated with surgery as either total or partial laryngectomy and combined with neck dissection revealed that the most common metastases were observed at the level IIA and level III; however metastases at level I, level IIB, level IV and level V were least common. Those findings indicated that selective neck dissection was a safe surgical approach (levels II-IV) in T1 T2 N0 cases. J Clin Exp Invest 2012; 3 (3): 368-371 Key words: Larynx cancer, cervical lymph node metastases, level ÖZET Amaç: Bu çalışmamızda boyun diseksiyonu yapılan larenks kanserli vakaların boyunda yapmış oldukları servikal metastazlarının boyundaki seviyelere göre dağılım sıklığını incelemeyi amaçladık. Aynı zamanda özellikle preoperatif N0 kabul edilen vakalarda kapsamlı bir boyun diseksiyonu yerine yapı-lacak olan selektif bir boyun diseksiyonun güvenli bir cerrahi yaklaşım olup olmayacağı araştırıldı. Gereç ve yöntem:Kliniğimizde boyundaki seviyelere göre metastaz sıklığının tespitinde kolaylık sağlaması açısından boyun diseksiyonu sonrası spesmen bölünerek her seviye ayrı ayrı patolojik incelemeye gönderilmektedir. Bizim çalış-mamızda 2005 ve 2010 yılları arasında Kulak Burun Boğaz Kliniği'nde larenks kanseri nedeniyle primer tedavi olarak cerrahi (total veya parsiyel larenjektomi) uygulanmış olan ve boyun diseksiyonu yapılan 145 hastanın dosyaları incelendi. Larenks kanseri tanısı almış olup cerrahi tedavide boyun diseksiyonu yapılma...

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Patterns of Cervical Node Metastases From Squamous Carcinoma of the Larynx

Cited by 168 publications

References 9 publications

Surgical Treatment of the Neck in Cancer of the Larynx

Surgical Treatment of the Neck in Cancer of the Larynx

The relationship between the frequency of cervical metastases and tumor related factors in laryngeal cancer and outcome of surgical treatment in these cases

Larenks kanserli hastalarda servikal metastazların boyundaki seviyelere göre dağılım sıklığı [The frequency of distribution of cervical metastases according to the neck level in patients with larynx cancer]

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