Surgical pathology of cancer of the larynx

Jh, Pogura

doi:10.1288/00005537-195510000-00001

Cited by 139 publications

(47 citation statements)

References 41 publications

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“…Surprisingly, of the 17 patients who had clinically N0 necks but pathologically positive nodes, 14 (82%) had involvement of the submandibular triangle. This finding represents a significant departure from previously reported series [22,42,46,49,50,[63][64][65][66][67][68][69][70][71][72][73][74][75]. This probably depends on accuracy in definition of levels I and II.…”

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

confidence: 75%

“…The incidence of supraclavicular (level V), middle (level III) and lower jugular (level IV) node metastases, which are only present after the involvement of the paratracheal nodes, is low [24]. Glottic, supraglottic, transglottic and subglottic cancers may metastasize to precricoid or prelaryngeal lymph node or Delphian node and to sub-Delphian nodes in the anterior tracheal compartment of level VI [23,[49][50][51][52][53][54][55]. Rarely, laryngeal cancer has metastasized to the axillary lymph nodes [56][57][58], and the axilla can become the major lymphatic drainage site from the anterior and lateral neck [58].…”

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

confidence: 99%

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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 Neckcontrasting

confidence: 75%

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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“…Ogura [27] found that positive nodes from laryngeal cancers can occur in all triangles of the neck except in the submental triangle. Translating this into the imaging-based nodal classification means that all nodal levels except level IA are at risk [28].…”

Section: The Classification and Laryngeal Cancer Metastasismentioning

confidence: 99%

The New Imaging-Based Classification for Describing the Location of Lymph Nodes in the Neck with Particular Regard to Cervical Lymph Nodes in Relation to Cancer of the Larynx

Som

Curtin²,

Mancuso³

2000

ORL

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For over five decades, the principle landmarks used in cervical nodal classification were clinical and defined either by palpation or found at the operative table. However during the past two decades, sectional imaging has consistently improved its quality and resolution and it has been shown that imaging can identify deep structures and adenopathy not amenable to palpation. Such disease can alter planned operative or radiation fields. In the April 1999 issue of the Archives of Otolaryngology – Head Neck Surgery, for the first time an imaging-based classification was published that gave precise anatomic landmarks for use in classifying metastatic cervical adenopathy. This classification was developed in consultation with head and neck surgeons so that the nodal levels classified by this imaging-based system would correspond closely with the nodal levels determined by utilizing the most commonly employed clinically-based classifications. This article describes this imaging-based classification and demonstrates its use with axial diagrams.

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“…2 The reason attributed was direct spread into the gland. However the incidence of thyroid involvement was noted to be around 10%.…”

Section: Discussionmentioning

confidence: 99%

Hypothyroidism in surgically treated T4 hypopharyngeal and laryngeal cancers

Janardhan

Varghese

Iype

et al. 2017

Int J Otorhinolaryngol Head Neck Surg

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Background: Total laryngectomy in laryngohypopharyngeal cancers, both in primary setting and salvage scenario, include variable amounts of thyroid resection. Although considerable proportion of these cases undergo total thyroidectomy, with an intention of wider surgical clearance, histopathological examination for thyroid infiltration, very often indicate that such resections are generally out of proportion to the actual oncological requirement.Methods: Forty three patients undergoing total laryngectomy with no prior thyroid dysfunction, from April 2014 to 2016, at our centre, were prospectively studied for post treatment, thyroid function with tests done at 6th month. Overt and occult hypothyroidism was correlated with extent of thyroid preserved intraoperatively. Results: Of 43 patients studied, 82% had extralaryngeal spread, and 16% of them showed thyroid gland infiltration. Only 7% were patholog1ically correlated for gland infiltration. Among those who had hemithyroidectomy, clinical hypothyroidism was seen in 20% primary and 85% salvage cases by 6th month of post treatment period.Conclusions: In clinicoradiologically favourable scenarios, thyroid preservation attempt helps to augment the neopharynx closure line and to preserve the parathyroids. Anatomical preservation however doesnot guarantee thyroid function, which needs regular follow up to avoid post-operative complications and better QOL.

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Surgical pathology of cancer of the larynx

Cited by 139 publications

References 41 publications

Surgical Treatment of the Neck in Cancer of the Larynx

Surgical Treatment of the Neck in Cancer of the Larynx

The New Imaging-Based Classification for Describing the Location of Lymph Nodes in the Neck with Particular Regard to Cervical Lymph Nodes in Relation to Cancer of the Larynx

Hypothyroidism in surgically treated T4 hypopharyngeal and laryngeal cancers

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