Significance of Retropharyngeal Node Dissection at Radical Surgery for Carcinoma of the Hypopharynx and Cervical Esophagus

Amatsu, Mutsuo; Mohri, Mitsuhiro; Kinishi, Minoru

doi:10.1097/00005537-200106000-00031

Cited by 81 publications

(52 citation statements)

References 6 publications

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“…Briefly, RPLNs are resected with primary site in an en bloc fashion, using a mandibular-splitting procedure or a mandibular resection [10] in most cases. When these procedures are not applied, we approach the retropharyngeal space by retracting the middle constrictor muscles medially and internal carotid artery laterally [9]. Node levels were determined by surgeon separating levels.…”

Section: Methodsmentioning

confidence: 99%

“…The finding of extracapsular spread (ECS) of the metastatic lymph nodes further decreases survival rates and is associated with increased rates of regional and distant metastases [5Á7]. In addition, metastases to retropharyngeal lymph nodes (RPLNs) also have been reported as a strong predictor of poor prognosis in head and neck cancers [3,8,9].…”

Section: Introductionmentioning

confidence: 99%

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Distribution and impact of lymph node metastases in oropharyngeal cancer

Shimizu

Inoue

Saitoh

et al. 2006

Acta Oto-Laryngologica

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Among the patients with tumor arising in the lateral wall or posterior wall, retropharyngeal nodes were involved in 29% (11/38), while RPLN metastasis was not observed in patients with tumors arising in the superior wall or anterior wall. The survival rate of patients with two or fewer positive lymph nodes was significantly better than that of patients with three or more positive lymph nodes (p < 0.05). The survival rate of the patients who had ECS was significantly worse than that of the patients who had lymph node metastases but not ECS (p < 0.05). There was no significant difference between the survival rates of the patients with and without RPLN metastases.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Distribution and impact of lymph node metastases in oropharyngeal cancer

Shimizu

Inoue

Saitoh

et al. 2006

Acta Oto-Laryngologica

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“…However, when RPLNs are treated surgically, the RPLN dissection is in conjunction with primary resection and standard neck dissection in patients with advanced carcinoma of the oropharynx and hypopharynx. RPLN dissection involves resection of this nodal basin up to the skull base along with the primary site in an en bloc fashion, using a mandibularsplitting procedure in most cases [7][8][9]. This approach divides the small nerves of the pharyngeal plexus in the process of separating the pharyngeal wall from the structures of the carotid sheath and can be associated with increased severity of dysphagia [10].…”

Section: Introductionmentioning

confidence: 99%

PET‐CT Staging of the Neck in Cancers of the Oropharynx: Patterns of Regional and Retropharyngeal Nodal Metastasis

et al. 2010

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Objective: To study the retropharyngeal lymph node status (RPLN) by pretreatment PET-CT imaging in patients with squamous cell carcinomas of the oropharynx (OPSCC). Study Design: Retrospective.Methods: 101 patients with a biopsy proven OPSCC were identified. 53 patients meeting inclusion criteria were further analyzed. Conclusions: Pre-treatment PET-CT can be used as a staging tool to aid in treatment planning of OPSCC, as rates of RPLN and nodal metastasis are consistent with those reported in the literature. Advanced T and N stage are associated with a greater odds ratio of being RPLN positive by PET-CT imaging.

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“…Metastatic involvement of the lateral retropharyngeal nodes may lead to secondary invasion and compression of the carotid sheaths [14]. Actually, there are several reports that advocate the dissection of the RPLNs during initial surgery in advanced tumors of the oropharynx, hypopharynx and cervical esophagus [9][10][11][14][15][16]. However, therapeutic RPLN dissection is technically challenging because of the limited surgical field and adhesion of the RPLNs to the surrounding tissue [14].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of superselective intra-arterial chemoradiotherapy targeting retropharyngeal lymph node metastasis

Suzuki

Sakashita

Homma

et al. 2016

Eur Arch Otorhinolaryngol

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Objective. We sought to evaluate the efficacy and feasibility of superselective intra-arterial infusion of high-dose cisplatin with concomitant radiotherapy (hereafter RADPLAT) for head and neck squamous cell cancer (hereafter HNSCC) patients with retropharyngeal lymph node (hereafter RPLN) metastasis. Study Design. Retrospective case series reviewSetting. University medical center in Japan Subjects and Methods. Ten HNSCC patients with RPLN metastasis treated by RADPLAT were analyzed.Results. The ascending pharyngeal artery was targeted for the treatment of RPLN metastasis in 9 patients. The median total dose of cisplatin was 26.6 mg/m2 (mean, 31.5 mg/m2; range, 11.7-87.9 mg/m2). In the remaining patient, the RPLN was supplied by the ascending palatine artery. As grade 3 and 4 adverse effects, leukopenia was observed in three, mucositis in four and nausea in one patient. No neurological complications were observed in any patients. Metastatic RPLNs were evaluated as a complete response in all patients. There was no recurrence of RPLN metastasis in any patients. Four patients remain alive without any evidence of disease and six patients died of disease. The 5-year overall survival rate was 50%.Conclusions. We have shown that superselective intra-arterial cisplatin infusion for RPLNs was a feasible and 2 effective approach for HNSCC patients with RPLN metastasis. INTRODUCTIONRetropharyngeal lymph node (RPLN) metastasis is considered to be a significant predictor of poor prognosis for patients with head and neck squamous cell carcinomas (HNSCCs) [1,2]. RPLN dissection is relatively simple and takes only a few minutes when performed electively. On the other hand, gross involvement of the RPLNs by the tumor can make the operation difficult and, at times, not feasible [3].Recently, superselective intra-arterial chemotherapy in combination with concomitant radiotherapy (RADPLAT) has been performed for patients with locally advanced HNSCC and has been reported to result in a favorable outcome, preserving function and improving survival [4,5]. We considered RADPLAT to be applicable to the treatment of RPLN metastasis and, therefore, assessed the efficacy and feasibility of this non-surgical treatment for HNSCC patients with RPLN metastasis. MATERIALS AND METHODSPatients. Two hundred thirty-five patients with untreated HNSCCs underwent RADPLAT in Hokkaido University Hospital, Japan between September 1999 and July 2012. In this study, we analyzed ten patients who 3 had RPLN metastasis. The primary tumor sites were the hypopharynx in six, the maxillary sinus in two, and the oropharynx in two patients. Eight patients were diagnosed with Stage IVA, one with Stage IVB, the remaining patient with stage III. Other detailed characteristics are shown in Table 1 Cisplatin infusion mainly targeted the primary tumor, RPLNs and sometimes metastatic lymph nodes. At the same time, sodium thiosulfate (20-24 g) was given intravenously to neutralize cisplatin toxicity [6]. All arterial catheterizations were accomplished transcutaneo...

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Significance of Retropharyngeal Node Dissection at Radical Surgery for Carcinoma of the Hypopharynx and Cervical Esophagus

Abstract: Bilateral dissection of the RPLN during initial surgery is highly recommended in every surgical case of carcinoma of the hypopharynx and cervical esophagus.

Cited by 81 publications

References 6 publications

Distribution and impact of lymph node metastases in oropharyngeal cancer

Distribution and impact of lymph node metastases in oropharyngeal cancer

PET‐CT Staging of the Neck in Cancers of the Oropharynx: Patterns of Regional and Retropharyngeal Nodal Metastasis

Effectiveness of superselective intra-arterial chemoradiotherapy targeting retropharyngeal lymph node metastasis

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