Central Compartment Neck Dissection in Laryngeal and Hypopharyngeal Squamous Cell Carcinoma: Clinical Considerations

Abstract

Metastatic lymph node involvement represents the most relevant prognostic factor in head and neck squamous cell carcinomas (HNSCCs), invariably affecting overall survival, disease-specific survival, and relapse-free survival. Among HNSCCs, laryngeal and hypopharyngeal cancers are known to be at highest risk to metastasize to the central neck compartment (CNC). However, prevalence and prognostic implications related to the CNC involvement are not well defined yet, and controversies still exist regarding the occult metastasis rate. Guidelines for the management of CNC in laryngeal and hypopharyngeal cancers are vague, resulting in highly variable selection criteria for the central neck dissection among different surgeons and institutions. With this review, the authors intend to reappraise the existing data related to the involvement of CNC in laryngeal and hypopharyngeal malignancies, in the attempt to define the principles of management while highlighting the debated aspects that are lacking in evidence and consensus. Furthermore, as definition and boundaries of the CNC have changed over the years, an up-to-date anatomical–surgical description of the CNC is provided.

Development and validation of a diagnostic model for predicting cervical lymph node metastasis in laryngeal and hypopharyngeal carcinoma

“…Research suggests that tumors in different locations exhibit significant differences in lymph node metastasis ( 11 ), particularly tumors in the hypopharynx, which are considered high-risk factors for lymph node metastasis, with a metastasis rate as high as 70% ( 30 , 31 ). Additionally, hypopharyngeal cancer is more likely to metastasize to the tracheal lymph nodes ( 32 ). In contrast, the lymph node metastasis rate for laryngeal cancer is only 16.2%, even in T4-stage laryngeal cancer cases, the metastasis rate remains only 36% ( 33 , 34 ), consistent with our predictive model, highlighting the significant impact of different tumor locations on the risk of lymph node metastasis.…”

Positive Delphian node in laryngeal cancer: Predictive of thyroid gland metastasis?

“…However, in their studies, some authors excluded thyroid metastasis from laryngeal cancer due to possible direct extension from primary tumour [ 4 , 9 ]. Indeed, thyroid gland involvement from metastatic cancer could occur through blood or lymphatic dissemination or direct spreading from adjacent organs, like larynx [ 8 , [10] , [11] , [12] ]. In their systematic review, Kumar et al proved that risk of thyroid involvement is greater in case of subglottic extension of the tumour [ 13 ].…”

The Diagnostic Value of CEUS in Assessing Non-Ossified Thyroid Cartilage Invasion in Patients with Laryngeal Squamous Cell Carcinoma

“…The role of imaging is more crucial in discriminating between T3 and T4 stages than between T1 and T2 stages according to the tumor-nodemetastasis (TNM) classification. As reported in the review by Deganello et al [4], patients with T4 stage tumors have a higher risk of developing lymph node metastases, which also affects both prognosis and treatment planning. Therefore, radiologists often face great challenges in evaluating subtle findings.…”