Neck and Mediastinal Node Metasis

Abstract

Objective: Evaluate details of neck node metastasis (NM) and mediastinal node metastasis (MM) in carcinomas of the pharyngolaryngoesophageal (PLE) region. Method: Chart review of 44 patients with gastric pull-up for Ca of the PLE junction (cervical esophageal, hypopharyngeal and advanced laryngeal carcinomas). The mediastinal dissection (MD) resected mainly the paratracheal/paraesophageal lymph nodes down to the aortic arch. Results: Fifty neck dissections (ND) were performed in 28 patients (positive nodes in 47.7%). The NM occurred in 22.2%, 60%, 70%, and 66.6% of patients with esophageal, pyriform sinus, retrocricoid, and laryngeal carcinomas, respectively. The number of neck nodes averaged 22.8 to 27.5 nodes per ND (positive in 12.5%) and was concentrated in levels II, III, and IV (84.3%). Extra capsular invasion (IE) occurred in 80.9%. Eighteen (48.6%) out of 37 patients had MM. MM occurred in 16.6%, 47.2%, and 64.2% of the patients with laryngeal, hypopharyngeal, and esophageal Ca, respectively. MD yielded 222 nodes, positive in 17%. EI occurred in 33%. Conclusion: A high number of ND was done with positive nodes in most therapeutic ND and nearly 50% of selective ND. EI was high (80.9%). Selective ND may suffice in esophageal carcinomas (NM in 22.2%). MM was significant, cervical esophageal carcinomas (64.2%) occurrence of MM in 47.2% of hypopharyngeal was disturbing.