Neck and mediastinal node dissection in pharyngolaryngoesophageal tumors.

Abstract

Specific reports about neck node metastasis in cervical esophageal tumors and mediastinal node metastasis in patients with pharyngolaryngoesophageal tumors are lacking. This study was undertaken to evaluate the need for neck and mediastinal lymph node dissection when dealing with carcinomas of this region. A retrospective review of the records of 34 patients who underwent total pharyngolaryngoesophagectomy and gastric transposition (TPLEGT) for squamous cell carcinoma of the pharyngoesophageal junction was done. Sixteen patients had esophageal carcinomas, 14 had hypopharyngeal carcinomas, and 4 had laryngeal carcinomas. The mediastinal dissection was designed to remove mainly the paratracheal and paraesophageal lymph nodes down to the aortic arch, without thoracotomy. Neck and mediastinal lymph node metastases were studied with specific reference to main primary site, and comparison with the literature was undertaken. Twenty-five neck dissections were performed in 19 patients and yielded positive nodes in 16 patients (47% of all patients). The neck nodes were positive in 75%, 64.2%, and 18.7% of the patients with laryngeal, hypopharyngeal, and esophageal carcinomas, respectively. Mediastinal dissection data were available on 27 patients, and 16 (59.2%) had mediastinal node metastasis. These mediastinal nodes were positive in 0%, 72.7%, and 61.5% of the patients with laryngeal, hypopharyngeal, and esophageal carcinomas, respectively. There is little controversy about neck dissections in tumors of the larynx and hypopharynx when a TPLEGT is contemplated. A similar situation applies to mediastinal dissections for cervical esophageal carcinomas. Although we observed a low incidence of positive neck nodes (18.7%) in patients with cervical esophageal carcinomas, there is a need for a larger prospective series. Our finding of 72.7% positive mediastinal nodes in hypopharyngeal carcinomas is high enough to deserve further study. Laryngeal carcinomas showed no positive mediastinal nodes in this series.