Is routine bilateral neck dissection absolutely necessary in the management of N0 neck in patients with supraglottic carcinoma? |
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Authors: | S Ça?l? I Yüce O G Yi?itba?? E Güney |
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Institution: | (1) Department of Otolaryngology, Head & Neck Surgery, Erciyes University Medical Faculty, Talas, Kayseri, Turkey |
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Abstract: | The supraglottic larynx has a rich lymphatic network that places patients with supraglottic laryngeal carcinomas at high risk
for early dissemination of the disease into the cervical lymphatics. Therefore, elective neck treatment of clinically N0 neck
in patients with supraglottic carcinomas is widely accepted as a standard approach. However, the issue whether elective neck
treatment should routinely be directed on both sides of the neck is still controversial. The present study is aimed at determining
whether T2–T4 stage supraglottic carcinomas require bilateral neck dissection in the management of N0 necks. We designed a
prospective study on 72 patients with N0 supraglottic laryngeal carcinoma. Patients were divided into three groups according
to the site and extension of the primary tumors. Group I consisted of 21 patients with lateralized (clear lateral) lesion
reaching but not crossing the midline. Group II comprised 25 patients with cancer largely involving one side and crossing
to the midline. Group III included 26 patients with carcinoma equally involving both sides of the larynx or growth into the
midline larynx. All patients underwent bilateral lateral neck dissection in conjunction with various types of laryngectomies
selected to the status of the primary. Of the 72 patients, 16 were found to have occult regional metastases in pathologic
examination (9 pN1, 4 pN2b, 3 pN2c). The prevalence of occult metastases proportionally increased with T stage from 8.3 to
22.7 and 31.2%, respectively, for T2, T3 and T4. Bilateral neck metastases were found in 2 of 26 patients (7.7%) with central
lesions. There was only one patient (4%) with both ipsilateral and contralateral lymph node metastasis in group II. None of
the 21 patients with lateral lesion (group I) had contralateral neck metastasis. Routine bilateral elective neck dissection
may not be a part of the surgical procedure in all supraglottic laryngeal carcinoma patients. Bilateral neck dissection should
be preferred for cases with central tumors and lateral tumors with positive nodes in the ipsilateral side of the neck. |
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Keywords: | Supraglottic carcinoma Neck dissection |
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