Post-laryngectomy stomal recurrence: tumour implantation or paratracheal lymphatic metastasis?

Rockley, T. J.; Powell, Jean; Robin, P. E.; Reid, A. P.

doi:10.1111/j.1365-2273.1991.tb01941.x

Cited by 50 publications

(45 citation statements)

References 14 publications

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“…Prognostic significance of this factor is controversial, as it is most frequently related to higher tumour stage as well as poorer overall performance status of patients and thus may not be an independent prognostic factor. It should be noted that the procedure alone may result in tumour cell implantation and, consequently, the development of recurrence [32,46,47,49]. The performed analysis and the above-cited literature reports indicate that individual prognostic factors, when considered alone, may sometimes lack prognostic significance.…”

Section: Discussionmentioning

confidence: 92%

“…Meredith et al [22] suggest irradiation of the pre-existing tracheostomy region. In the literature reports, the recurrence rates in patients who have undergone emergency tracheostomy range between 27% and 71% [7,43,46,47,48]. Prognostic significance of this factor is controversial, as it is most frequently related to higher tumour stage as well as poorer overall performance status of patients and thus may not be an independent prognostic factor.…”

Section: Discussionmentioning

confidence: 99%

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Histopathological factors influencing results of combined treatment in patients with laryngeal cancer

Mucha-Małecka¹,

Składowski²,

Lange³

2015

pjp

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The aim of the study was to assess the prognostic value of postoperative histopathological factors as well as the clinical usefulness of the modified risk score for recurrence. In a group of 197 patients with laryngeal cancer who underwent surgery followed by radiation therapy, partial resection was performed in 21.5% of patients and total resection in 78.5%. The majority of patients had T3 or T4 (74%) and N0 (63%) cancer. Macroscopically positive margins were reported in 10% of patients after partial resection and in 7% of patients after total resection, whereas microscopically positive margins were observed in 31% and 20% of cases, respectively. Extracapsular extension was observed in 22% of patients. In order to estimate local and nodal recurrence risk rates, criteria developed by Peters were used. Five-year local control (LC) was achieved in 88% of patients, disease-free survival (DFS) in 68% of patients and overall survival (OS) in 73% of patients. In the case of macroscopically positive margins, the 5-year DFS was 33% lower compared to radical surgery and 25% lower in the case of microscopically positive margins. The 5-year DFS was reduced by 29% due to extracapsular extension. Cox model analysis indicated that the degree of recurrence risk was the most potent independent prognostic factor for postoperative radiation therapy in laryngeal cancer. Negative histopathological factors influencing results of combined treatment of laryngeal cancer include macro-and microscopically positive margins, neck lymph node involvement and extracapsular extension.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Histopathological factors influencing results of combined treatment in patients with laryngeal cancer

Mucha-Małecka¹,

Składowski²,

Lange³

2015

pjp

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“…Although the lack of prospective studies is responsible for us not having enough information about the ideal surgical approach in the NO neck, elective neck dissection is always advocated when the risk of microscopic lymphnode disease in the neck exceeds 20% 16 . In larynx tumors, especially those that affect the infraglottic region, the lymphnode group at risk would be the paratracheal and pre-tracheal lymphnode chain, and it is possible if these are not properly investigated and treated, that they would be involved in the recurrence we see in the tracheostoma area 10,24,25 . These lymphnodes are rarely palpable and are not routinely included in neck dissections.…”

Section: Discussionmentioning

confidence: 99%

“…The different treatment modalities for these recurrences, that include surgery, radio and chemotherapy, have not been satisfactory to control the disease, and therefore, a special attention has been given to the prevention of such pathology 2,[8][9][10] . Many methods have been proposed to prevent recurrence in the tracheostoma area, such as: lower trachea section allowing for a broader surgical margin, dissection of lymphnodes located in the paratracheal chains, emergency laryngectomies in patients that required tracheostomy prior to their laryngectomy, postoperative radiotherapy including the tracheostoma and the upper mediastinum 1,3,7,11 .…”

Section: Introductionmentioning

confidence: 99%

“…Many methods have been proposed to prevent recurrence in the tracheostoma area, such as: lower trachea section allowing for a broader surgical margin, dissection of lymphnodes located in the paratracheal chains, emergency laryngectomies in patients that required tracheostomy prior to their laryngectomy, postoperative radiotherapy including the tracheostoma and the upper mediastinum 1,3,7,11 . Historically, recurrences in the tracheostoma area are considered very difficult to treat and are associated to little likelihood of survival 10,[12][13][14][15] . The goal of the present study is to investigate the cases of patients in our institution who suffered laryngectomy between the years of 1995 and 2004, and analyze the cases in which there was tumor recurrence in the tracheostoma area by means of the clinical findings in these patients, trying to identify some risk factors in the causation of such pathology and what could prevent it.…”

Section: Introductionmentioning

confidence: 99%

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Recorrência na área do traqueostoma após laringectomia total

Sartini

Fava

Faria

2007

Rev. Bras. Otorrinolaringol.

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St oma recurrence after total laryngectomy is one of the most severe developments of squamous cell carcinoma of the larynx. Risk factors most strongly implicated in stoma recurrence have been subglottic invasion by the laryngeal tumor and tracheotomy prior to laryngectomy. Aim: Study the clinical findings of patients who underwent total laryngectomy and evaluate the probable risk factors to the development of stoma recurrence. Study design: Descriptive and retrospective study Materials and methods: We studied data from 47 patients who underwent total laryngectomy for the treatment of laryngeal cancer between 1995 and 2004 and evaluated recurrences and risk factors. Results: Stoma recurrence developed in 10.6 per cent of them(5 cases). There was no significant correlation between stoma recurrence and subglottic invasion or prior tracheotomy. Conclusion: Stoma recurrence still is one of the most lethal developments associated to laryngeal cancer. In the present study it was not possible to identify factors related to this recurrence. Further studies with a larger sample and a longer follow-up period are necessary to better understand this condition.

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Paratracheal lymph node dissection in cancer of the larynx, hypopharynx, and cervical esophagus: The need for guidelines

et al. 2011

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In laryngeal, hypopharyngeal, and cervical esophageal carcinomas, the paratracheal lymph nodes (PTLN) may be at risk for lymph node metastasis. The presence of PTLN metastasis is an important prognostic factor for the development of mediastinal and distant metastases, stomal recurrence, and disease-free and overall survival. Studies on PTLN metastasis are scarce. In most studies, PTLN dissection has not been routinely performed, and selection criteria for PTLN dissection are usually not well defined. Therefore, in most reported studies, selection bias is present and results are difficult to compare. The reported prevalence of PTLN metastases varies according to the site and stage of the primary tumor: subglottic cancer, transglottic cancer, and glottic cancer with subglottic extension have a higher risk of PTLN metastases. Diagnostic imaging is not sufficiently reliable to detect occult PTLN metastases and avoid unnecessary PTLN dissections. PTLN dissection is associated with limited morbidity, but damage to major vessels may occur, and because of exposure of these vessels PTLN may increase the morbidity of fistulae that can occur after total laryngectomy. The dissection may produce hypocalcemia, if performed bilaterally. Nevertheless, the limited morbidity and high rate of metastasis in specific laryngeal, hypopharyngeal, and cervical esophageal carcinomas argue in favor of routine elective PTLN treatment for these tumors. Large prospective studies are needed to identify the patients at risk with primary tumors in more detail. Moreover, improved diagnostic imaging is needed to detect (occult) PTLN metastases more reliably. Based on future studies, clinical guidelines have to be developed to avoid undertreatment and overtreatment.

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Post-laryngectomy stomal recurrence: tumour implantation or paratracheal lymphatic metastasis?

Cited by 50 publications

References 14 publications

Histopathological factors influencing results of combined treatment in patients with laryngeal cancer

Histopathological factors influencing results of combined treatment in patients with laryngeal cancer

Recorrência na área do traqueostoma após laringectomia total

Paratracheal lymph node dissection in cancer of the larynx, hypopharynx, and cervical esophagus: The need for guidelines

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