Indication of elective contralateral neck dissection in squamous cell carcinoma of the hypopharynx

Ali Amar,Rogério Aparecido Dedivitis,Abrão Rapoport,André Luiz Quarteiro

doi:10.1016/s1808-8694(15)30485-7

Abstract

SummaryLymph node metastases (LNM) are common in hypophariyngeal carcinomas; the neck dissection is an important therapeutic approach.Aimto analyze the incidence and distribution of LNM and failures in treating the contralateral neck.Methodsa retrospective study of 174 patients with hypopharyngeal cancer treated from 1978 to 2003. The distribution of LNM and regional recurrences were evaluated.Results44% of the cases were false negatives and 4.9% were false positives. Among the 48 patients who underwent bilateral ND, 29 had bilateral metastases and one had contralateral metastasis. Contralateral neck recurrences occurred in 12 cases that underwent unilateral ND. Among the nine patients with contralateral neck recurrence alone, eight were surgically salvaged. The risk of contralateral metastases was related to clinical staging (p=0.003) and involvement of the medial wall of the pyriform sinus (p=0.03), but not to radiotherapy (p=0.28).ConclusionContralateral metastases were more frequent when the medial wall of the pyriform sinus was affected, in the presence of ipsilateral palpable metastases and clinical stage IV.

Highlights

Lymph node metastases occur frequently in hypopharyngeal carcinomas, and may be a patient’s first manifestation
Based on the description of the initial physical examination and surgical findings, the incidence, laterality and relation with the primary tumor of lymph node metastases was defined at these levels
False positive cases are rare; metastases may occur at most lymph node levels, the frequency is low in level I

Summary

Introduction

Lymph node metastases occur frequently in hypopharyngeal carcinomas, and may be a patient’s first manifestation. The rate of false negatives is about 40% even in cases with no palpable lymph nodes. Therapeutic or elective neck dissection is an important aspect of therapy.[1] Knowledge about regional dissemination is relevant for unilateral or bilateral neck dissection, especially when done electively, since the extent of this procedure will reflect on postoperative morbidity and mortality and regional disease control. Lymphatic drainage and the distribution of metastases are known, indications for neck dissection are still debated. The purpose of this study was to evaluate the incidence and distribution of lymph node metastases and treatment failure of regional disease in hypopharyngeal squamous cell carcinoma, with an emphasis on the treatment of the contralateral neck

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