Efficacy of routine bilateral neck dissection in the management of the N0 neck in T1–T2 unilateral supraglottic cancer

Rodrigo, Juan P.; Cabanillas, Rubén; Franco, Virginia; Suárez, Carlos

doi:10.1002/hed.20359

Cited by 39 publications

(39 citation statements)

References 25 publications

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“…Almost half of the patients with supraglottic tumors had central tumors, such a situation that requires bilateral treatment. In lateralized lesions, when there are histologically confirmed metastases in the ipsilateral side, contralateral metastases happen in up to 48% of the cases, while in stages I and II this frequency is of only 5% 5,6 . Although the T staging (TNM -UICC/AJCC) is very important in the definition of the risk of ipsilateral metastases, its relationship with the risk of contralateral metastases seems to be indirect, considering that the tumor size is associated to the possibility of reaching areas (anatomical subsites) with crossed lymphatic drainage.…”

Section: Discussionmentioning

confidence: 95%

Esvaziamento cervical no carcinoma epidermoide de laringe: indicação de esvaziamento eletivo contralateral

Amar

Chedid²,

Franzi³

et al. 2012

Braz. j. otorhinolaryngol.

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Uni lateral or bilateral neck dissection must be considered in the treatment of laryngeal cancer Aim: To evaluate the prevalence of contralateral metastases in larynx cancer and distribution of these metastases according to lymph node levels in the neck. Method:Retrospective longitudinal study of 272 charts from patients with squamous cell cancer of the larynx treated between 1996 and 2004; and we selected 104 surgical cases submitted to neck dissection. We evaluated the incidence of bilateral or contralateral metastases, according to the location and extension of the primary tumor, considering the anatomical sub-sites and the midline.Results: Contralateral metastases in lateral tumors were observed in 3.5% of glottic lesions and in 26% of supraglottic lesions. Contralateral metastases were uncommon in N0 patients. Lymph nodes levels IIa and III were the most commonly involved in the neck. Conclusion:In lateral glottic tumors there is no need for elective contralateral neck dissection. In supraglottic lesions without ipsilateral metastases, the incidence of hidden metastasis does not justify elective contralateral dissection. The midline is not a reliable indicator of the risk of contralateral laryngeal tumors. Braz J Otorhinolaryngol. 2012;78(2):7-10. ORIGINAL ARTICLE BJORL

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Section: Discussionmentioning

confidence: 95%

Esvaziamento cervical no carcinoma epidermoide de laringe: indicação de esvaziamento eletivo contralateral

Amar

Chedid²,

Franzi³

et al. 2012

Braz. j. otorhinolaryngol.

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“…[25][26][27] Such a tactic is based on the knowledge that supraglottic cancer, even during early local stage, is characterized by a significant incidence of occult metastases in the neck. 28,29 Moreover, it has been previously shown that the survival of patients with supraglottic cancer is largely determined by this high rate of cervical node metastases, and failure in the neck is generally the most likely cause of treatment failure.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of available surgical management options for early supraglottic cancer

et al. 2009

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“…17 Bizim çalışmamızdaki 108 supraglottik kanserli vakanın 49'unda (%45.3) ipsilateral servikal metastaz, 25 vakada (%23) ise occult metastaz saptandı. Kowalski ve arkadaşları, 6 yaptığı çalışmada, transglottik tümörlerde servikal metastaz oranını %41 olarak rapor etmişlerdir.…”

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“…Bir görüşe göre primer tümörün yerleşim ve uzanımına göre daha yüksek metastaz riski olan boyun bölgesine ipsilateral boyun diseksiyonu yapmak gereklidir. 17,19,33 Bir kısım yazar ise N0 boyunlarda, bilateral elektif boyun diseksiyonu önermektedirler. [34][35][36] Çünkü görünüşte negatif olan diseksiyonların bile %5-8'inde rutin patolojik incelemelerle mikrometastaz tespit edilmiştir.…”

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“…39,40 Ayrıca yapılan bir çalışmadada, ipsilateral boyun disseksiyonu yapıldığı halde metastaz tespit edilmeyen %5.5 oranında bir hasta gurubunda kontralateral tarafta ileriki dönemlerde nüks geliş-miştir. 17 Bizim çalışmamızda da boyun disseksiyonu yapıldığı halde metastaz tespit edilmeyen hastaların 12'sinde ileriki dönemlerde servikal nüsle karşı-…”

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The relationship between the frequency of cervical metastases and tumor related factors in laryngeal cancer and outcome of surgical treatment in these cases

Şengül

Bağlam²,

Çevik³

et al. 2012

J Clin Exp Invest

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Objectives: We aimed to assess the associations between localization, size, stage and histopathological differentiation of primary tumor in larynx and neck metastases and the impact of disease stage on survival. Materials and methods:We analyzed the medical records of 333 laryngeal cancer patients who underwent total or partial laryngectomy as primary treatment, combined with neck dissection and/or postoperative radiotheraphy if required, between 2000 and 2010 years at our clinic. Age and gender of patients, tumor localization, size, stage and histopathological differentiation of tumor; presence of preoperative positive lymph nodes, performed operations, operation findings and histopathological results were analysed retrospectively. Results:Tumor localizations were glottic in 172 (51.6%) cases, supraglottic in 108 (32.4%), and transglottic 53 (15.9%) of the the cases. In glottic cancers; cervical metastases were observed in 18.6% of the patients, whereas occult metastases in 11%. In supraglottic cancers; cervical metastasis rate was 45.3% and occult metastases rate was 24%. In transglottic cancers, cervical metastases rate was 49% and occult metastases was 22.6%. Postoperative recurrence was 41 (12.3%). Postoperative radiotherapy was recommended to 111 of 333 patients. The overall survival rate was 75.4% at 50th month and the cumulative survival rate was 68.9%. Conclusion:In conclusion, although there is controversy regarding the optimal treatment in the N0 larynx cancers, in case of a high risk for occult metastases, elective unilateral or bilateral neck dissection should be performed according to the anatomic localization of the tumor. In addition, survival rate decreased significantly with the increasing tumor stage. J Clin Exp Invest 2012; 3(2): 214-222Key words: Larynx cancer, localization, stage, cervical lymph node metastases, survival ÖZET Amaç: Çalışmamızda larenkste tespit edilen primer tümörün lokalizasyonu, büyüklüğü, evresi, histopatolojik diferansiasyon derecesi, tutmuş olduğu anatomik yapı ile boyun metastazı arasındaki ilişkisi ve tümörün evresinin sağkalım üzerine olan etkisini araştırdık. Gereç ve yöntem:Kliniğimizde 2000-2010 yılları arasında larenks kanseri nedeniyle primer tedavi olarak cerrahi (total veya parsiyel larenjektomi) uygulanmış olan, gerektiğinde boyun diseksiyonu yapılan ve gerektiğinde postoperatif radyoterapi uygulanan 333 hastanın dosyaları incelendi. Hastaların yaşı, cinsiyeti, tümörün lokalizasyonu, tümörün büyük-lüğü, tümörün evresi, histopatolojik diferansiasyon derecesi, preoperatif pozitif lenf nodu bulunup bulunmadığı, yapılan ameliyatlar, ameliyat bulguları ve postop spesmenin histopatolojik değerlendirme sonuçları retrospektif olarak incelendi. Bulgular: Tümörün yerleşim bölgesine göre; vakaların 172'si (%51.6) glottik, 108'i (%32.4) supraglottik, 53'ü (%15.9) ise transglottik yerleşimliydi. Glottik tümörlerde %18.6 oranında servikal metastaz, %11 oranında occult metastaz tespit edilirken, supraglottik tümörlerde %45.3 oranında servikal metastaz, %24 oranında...

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Efficacy of routine bilateral neck dissection in the management of the N0 neck in T1–T2 unilateral supraglottic cancer

Abstract: This study suggests that routine bilateral neck dissection may not be necessary in the surgical treatment of all supraglottic cancers.

Cited by 39 publications

References 25 publications

Esvaziamento cervical no carcinoma epidermoide de laringe: indicação de esvaziamento eletivo contralateral

Esvaziamento cervical no carcinoma epidermoide de laringe: indicação de esvaziamento eletivo contralateral

Evaluation of available surgical management options for early supraglottic cancer

The relationship between the frequency of cervical metastases and tumor related factors in laryngeal cancer and outcome of surgical treatment in these cases

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