Paratracheal lymph node dissection, in which patients should it be performed?

OBJECTIVES: This study aims to evaluate the effect of paratracheal lymph node (PTLN) metastasis on survival in patients with advanced laryngeal and hypopharyngeal cancer.

PATIENTS AND METHODS: Medical records of advanced laryngeal and hypopharyngeal cancers who underwent surgery between May 1995 and June 2008 were assessed and 78 of the patients (63 males, 15 females; mean age 55±11.3 years; range 25 to 76 years) who has PTLN metastasis were included in this study. The mean follow-up period was 23 months. Fifty-three patients had primary laryngeal cancer, and the remaining 25 patients had primary hypopharyngeal cancer.

RESULTS: Paratracheal lymph node metastasis was detected in eight (15%) of 53 patients with laryngeal carcinoma, six (42%) of 14 patients with postcricoid carcinoma, and one (14%) of seven patients with posterior pharyngeal wall carcinoma. Paratracheal lymph node metastasis was not detected in patients with pyriform sinus carcinoma (n=4). Paratracheal lymph node metastasis was detected in a total of 15 patients, of whom 11 had extranodal spread (ENS). Multivariate analysis showed that the presence of ENS was the most effective prognostic factor on the overall survival (p<0.0005).

CONCLUSION: The presence of PTLN metastasis with ENS is an important prognostic indicator on overall survival. We recommend PTLN dissection particularly in patients with advanced laryngeal or hypopharyngeal cancer for histopathological analysis and prognostication because ENS can only be precisely detected by pathological evaluation.