Prognostic Value of the Prelaryngeal Node in Laryngeal and Hypopharyngeal Carcinoma

Resta, Leonardo; Micheau, C; Cimmino, Antonietta

doi:10.1177/030089168507100407

Cited by 34 publications

(28 citation statements)

References 8 publications

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“…DN was isolated in 86.8% of the patients, three (6.5%) were positive; two of patients died from nodal and parastomal recurrence. [4]. Positive DN was conWrmed in 16 out of 212 patients (7.5%) according to the materials presented by the authors.…”

Section: Discussionmentioning

confidence: 84%

“…DN was mentioned by Olsen et al [3], Resta et al [4], Szmeja et al [5] and Gawlak-Prycka [6] as a crucial structure in laryngeal cancer spread, predicting extensive lymph node disease and an unfavourable prognosis regardless of the primary site or stage. All of the above-mentioned authors carried out non-randomised studies, which included highly advanced laryngeal cancer patients.…”

Section: Introductionmentioning

confidence: 99%

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The impact of prelaryngeal node metastases on early glottic cancer treatment results

Wierzbicka

Leszczyńska

Młodkowska

et al. 2011

Eur Arch Otorhinolaryngol

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The aim of the study was to examine the impact of positive prelaryngeal node on the outcome of early glottic cancer and to compare the rate of local and regional recurrences and overall survival rates in patients with positive and negative Delphian node (DN). In the years 1989-2008, a consecutive cohort of 212 patients with T1b and T2 glottic cancer with anterior commisure involvement were treated by means of supracricoid partial reconstructive laryngectomies. No adjuvant radiotherapy was administered. Out of 212 patients, in 75 suspected prelaryngeal tissue was found, harvested and separately sent for histological investigation (16-thyroid, 11-fat, 14-connective tissue, 34-lymph nodes). In 137 remaining cases, there were only muscles and fascia without even a small amount of tissue to be taken. In 16 cases out of the whole group, metastases were found. 33 patients with positive ultrasound findings on the lateral neck underwent selective neck dissection; in 4 cases metastases were confirmed. Local and regional recurrence developed in 37 out of 212 patients (17.5%). There was significant correlation between local relapse and prelaryngeal node metastases; out of 20 cases with local recurrence, 13 had positive DN (P < 0.005). There was also significant correlation between nodal relapses and DN metastases; out of 22 cases with nodal relapse, 12 had positive DN and 10 were DN negative (P < 0.005). The organ preservation rates for DN positive and DN negative patients were 62.5 and 93.88%, respectively. There was noted a significant difference in the mean survival between the groups with positive and negative DN (P = 0.004; 38.7 vs. 49.3 months, respectively). In conclusion, positive DN seems to be a strong isolated factor influencing prognosis in patients with early glottic cancer. DN metastases are responsible for the increased rates of local and nodal relapses, decreased chances of organ preservation and poor overall survival rates.

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Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

The impact of prelaryngeal node metastases on early glottic cancer treatment results

Wierzbicka

Leszczyńska

Młodkowska

et al. 2011

Eur Arch Otorhinolaryngol

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“…The incidence of supraclavicular (level V), middle (level III) and lower jugular (level IV) node metastases, which are only present after the involvement of the paratracheal nodes, is low [24]. Glottic, supraglottic, transglottic and subglottic cancers may metastasize to precricoid or prelaryngeal lymph node or Delphian node and to sub-Delphian nodes in the anterior tracheal compartment of level VI [23,[49][50][51][52][53][54][55]. Rarely, laryngeal cancer has metastasized to the axillary lymph nodes [56][57][58], and the axilla can become the major lymphatic drainage site from the anterior and lateral neck [58].…”

Section: Choice Of Surgical Procedures For Elective Treatment Of the Neckmentioning

confidence: 99%

Surgical Treatment of the Neck in Cancer of the Larynx

Ferlito¹,

Silver²,

Rinaldo³

et al. 2000

ORL

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Current concepts in management of the clinically negative and clinically positive neck in laryngeal cancer are reviewed. Occult disease in the neck not detected by physical and radiographic examination may also be difficult to identify on routine histologic examination. Immunohistochemistry or molecular analysis may detect metastatic involvement not apparent by light microscopy. The surgeon should be aware of the relatively high incidence of micrometastases in patients with laryngeal cancer to establish optimal treatment approaches. Elective treatment of the neck is recommended for supraglottic tumors staged T2 or higher, and glottic or subglottic tumors staged T3 or higher.The neck may be treated electively by either surgery or irradiation, but irradiation is best reserved for cases where that modality is employed for the primary tumor. Elective neck dissection provides important information for prognostic purposes and therapeutic decisions, by establishing the presence, number, location and nature of occult lymph node metastases. The selective lateral neck dissection (levels II, III and IV), unilateral or bilateral, is the procedure of choice for elective treatment. Paratracheal nodes (level VI) should be dissected in cases of advanced glottic and subglottic cancer. Complete radical or functional neck dissections are excessive in extent, as levels I and V are almost never involved. Sentinel lymph node biopsy may fail to detect tumor on frozen section examination or may not reveal ‘skip’ metastases.The clinically involved neck is usually treated by complete radical or functional neck dissection of levels I through V. Selective neck dissection has been employed successfully in selected cases, particularly for N1 or occasionally N2 nodal involvement. The selective neck dissection can be extended to include structures at risk. More advanced disease has been treated in this manner often in association with adjuvant chemotherapy and/or irradiation. While the benefit of adjuvant treatment is difficult to assess, it appears most useful in cases with extranodal spread of disease, a factor associated with the worst prognosis.

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“…In 1985, Resta et al (5) investigated 124 cases of laryngeal and hypopharyngea l cancer selected from : 900 total laryngectomies and pharyngolaryngectomies cases seen at the Gustave-Rouss y Institut over the years 1969 -79. Metastasis in a prelaryngeal node was noted in 26 cases.…”

mentioning

confidence: 99%

“…The 5-year survival rate in these patients was very poor: only 3 patients (11.5%) were alive and free of disease. Resta et al (5) concluded that the presence of metastasis in the Delphian node is a signi cant unfavorabl e prognostic factor.…”

mentioning

confidence: 99%

Prognostic Value of Delphian Lymph Node Metastasis from Laryngeal and Hypopharyngeal Cancer

Ferlito

Shaha

Rinaldo

2002

Acta Oto-Laryngologica

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Prognostic Value of the Prelaryngeal Node in Laryngeal and Hypopharyngeal Carcinoma

Cited by 34 publications

References 8 publications

The impact of prelaryngeal node metastases on early glottic cancer treatment results

The impact of prelaryngeal node metastases on early glottic cancer treatment results

Surgical Treatment of the Neck in Cancer of the Larynx

Prognostic Value of Delphian Lymph Node Metastasis from Laryngeal and Hypopharyngeal Cancer

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