The Indication of Neck Dissection in Treatent of Supraglottic Cancer

Abstract

Background and Objective：In supraglottic cancer the incidence of lymph node metastsis is higher than other subsites. One of the major controversies in treatment of the supraglottic cancer is how to manage the possibility of neck disease. This study was designed to find out the incidencies of ipsilateral and contralateral lymph node metastasis and to establish the indication of neck dissection according to T stage. Materials and Methods：A retrospective review was undertaken of 49 cases of supraglottic carcinoma at the department of otolaryngology, Pusan National University Hospital between March 1986 and February 1992. Results：In our series of 49 patients, 14 cases had no neck dissection, 19 had unilateral neck dissections, and 16 underwent bilateral neck dissection. Rate of ipsilateral neck metastasis according to T stage was 0% in T 1 , 40.9% in T 2 , 59.1% in T 3 and 75.0% in T 4 respectively. Rate of contralateral neck metastasis according to T stage was 0% in T 1 , 18.2% in T 2 , 13.6% in T 3 and 0% in T 4 , respectively. Seven neck failure cases were noted during follow up. Only 2 of the 30 neck dissections had recurred on previous dissected necks. The remaining 5 neck metastasis occurred in unoperated necks, only 1 of those was deemed contralateral to the primary lesion. Rate of subsequent ipsilateral neck recurrence in case of ipsilateral negative nodal metastasis during follow up was 26.6% 4/15 cases . Oveall, 2 year survival rate in negative necks was 66.7%, and that of positive neck was 50.0%. Conclusion：Overall, incidence of ipsilateral lymph node metastasis was 51.0%. Most neck recurrences occured in untreated or radiated ipsilateral necks. Therefore, studies indicate routine neck dissection should be considered in surgical treatment of supraglottic carcinoma.