Pathogenetic interpretation of neoplasm recurrences on the tracheostoma in patients laryngectomized for carcinoma

Abstract

Of 519 patients subjected to total laryngectomy for cancer 14 had a recurrence of the tumor on the tracheostoma. The various possible pathogenetic mechanisms are reviewed critically in the light of this material. Non-radicality of the operation seems to be the most probable, in view of the peculiar lymph spread of neoplastic cells. The lymph drainage system of the larynx is described, with special reference to the crossing of the lymphatic networks at the level of the subglottic region. Although the normal direction of the lymph flow of this region is almost entirely upward, several anatomic and pathologic alterations can stop these pathways and reverse the lymph flow, in which case some of the lymph reaches the vessels of the tracheal network. When the trachea is divided during laryngectomy or when tracheotomy is performed, neoplastic cells spread out of the severed vessels and are imprisoned by the suture of the tracheostoma and the healing process. They thus elude the biological defense mechanisms (which may be present also in the lymph nodes) and so a tumor forms on the new site. This interpretation is supported by the high rate of recurrence on the tracheostoma (17.5%) after long-term use of a tracheostomy tube, especially in cases of tumor of the subglottic region or of the glottis.