Neck and mediastinal node dissection in pharyngolaryngoesophageal tumors

Abstract

There is little controversy about neck dissections in tumors of the larynx and hypopharynx when a TPLEGT is contemplated. A similar situation applies to mediastinal dissections for cervical esophageal carcinomas. Although we observed a low incidence of positive neck nodes (18.7%) in patients with cervical esophageal carcinomas, there is a need for a larger prospective series. Our finding of 72.7% positive mediastinal nodes in hypopharyngeal carcinomas is high enough to deserve further study. Laryngeal carcinomas showed no positive mediastinal nodes in this series.

Noncervical Lymph Node Metastasis from Head and Neck Cancer

“…Rucco and Amatulli [13], Som [14] and DiSantis et al [15] also showed mediastinal involvement by head and neck carcinomas. A recent study by Martins [4] with 35 patients who underwent upper mediastinal dissection due to tumors located as follows: cervical esophagus (16 cases), pyriform sinus (7 cases), postcricoid (7 cases), larynx (4 cases) and pharyngoesophageal recurrence of a thyroid carcinoma (1 case). Of the 28 cases who were analyzed, 17 (60.7%) had mediastinal metastasis: esophagus, 8/13 (61.5%); hypopharynx, 8/11 (72.7%); larynx, 0/3; recurrent thyroid carcinoma, 1/1.…”

“…Whenever axilla is the only site of cancer recurrence, a standard axillary dissection must be considered [23]. Upper mediastinal metastases from subglottic and hypopharyngeal cancer are managed by paratracheal and mediastinal dissection through the neck [3,4] and postoperative radiotherapy. The mediastinal dissection includes all paratracheal lymph nodes, brachiocephalic artery nodes, and paraesophageal nodes, down to the aortic arch (the inferior limit of the dissection).…”

“…However, axillary and mediastinal metastases can in fact represent a contiguous regional dissemination of disease. Metastases to lymph nodes of the upper mediastinum are very common among patients with subglottic and hypopharyngeal squamous cell carcinoma (SCC) [2][3][4]. Metastases of thyroid cancer to mediastinal lymph nodes are classified as regional (N1b), and metastases to inguinal, peribronchial and abdominal lymph nodes are classified as distant metastasis (M1).…”

Upper Mediastinal Node Dissection for Hypopharyngeal and Cervical Esophageal Carcinomas

“…Some reports have indicated that the incidence of upper mediastinal metastasis is not high in HPC patients (6.6% to 17%), 6-8 but Martins 4 reported an exceptionally high incidence of 72.7%. Risk factors for mediastinal metastasis have not been fully described.…”

“…4,9,10 Therefore, MD is an accepted procedure for esophageal cancers. Howev- These reports strongly recommended upper MD for Ce, but postoperative morbidity and mortality has been of concern.…”