Peristomal recurrence following primary total laryngectomy: the enigma of the central compartment neck lymph nodes

Abstract

Purpose of reviewThe practice of primary total laryngectomy (TL) for advanced laryngo-hypopharyngeal cancer has significantly declined in the developed countries. The treatment options most frequently adopted have changed from open surgery to transoral laser or robotic approaches or nonsurgical (bio-chemo-) radiotherapy. Primary TL remains the treatment of choice in the developing world where healthcare resources are limited, especially for the treatment of cancer. Recent findingsPeristomal recurrence (PSR) is quite a serious complication, with an incidence of 6.6% from the published literature (mainly concerning the developed world), most diagnosed within 2 years, and associated with >80% mortality. The major risk factors include pretreatment tracheostomy, specific primary tumor subsites, positive surgical margins, and presence of nodal metastasis. The treatment options are limited and most success has been observed with surgery, especially when PSR is diagnosed at an early-stage, which is uncommon. Treatment of advanced-stage disease is usually palliative. Reduction and/or prevention of the known risk factors for PSR remain the goal when performing TL. In particular, central compartment (paraand pretracheal) lymph nodes dissection in case of large tumors with extra-laryngeal and/or subglottic extension or pretreatment tracheotomy plays a paramount role in PSR prevention. SummaryResearch is required to conclude the formulation of guidelines for proper dissection of the central compartment (level VI) lymph nodes as indicated either prophylactically or therapeutically during TL for preventing PSR.

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 ].…”