Surgical nodal management in hypopharyngeal and laryngeal cancer

Objective The aim of this study is to compare pre-therapeutic staging of the loco-regional lymphatic basin and subsequent surgical management in cN0 versus cN+ hypopharyngeal and laryngeal cancer patients.

Methods We analyzed all hypopharyngeal and laryngeal carcinoma patients treated surgically at a single quaternary medical care and cancer center between 2004 and 2014. We established two groups for patients who underwent neck dissection referring to patients with a low LNR (lymph node ratio) versus one with a high LNR. Regarding the cN0 cohort elective neck dissection has been evaluated as a secondary predictor variable. Comorbidities, as anemia and renal insufficiency, have been analyzed to potentially influences disease-free (DFS) and overall survival (OS).

Results 310 patients (185 glottic and 125 supraglottic/hypopharyngeal carcinoma) have been included. Pre-therapeutic neck MRI-/CT-scan and concomitant neck ultrasound revealed cN+ status in 144 patients resulting in a significant over-staging in 63 patients (44 %) who were attributed being pN0 after histological examination. 166 patients got staged cN0 and 21 underwent elective neck dissection (11 local advanced glottic and 10 supraglottic/hypopharyngeal carcinoma). Two cN0 patients showed occult cervical lymph node metastases (9.5 %). Furthermore, we could detect a significant increasing association for dissected lymph nodes, the LNR, and OS.

Conclusion The pre-therapeutic clinical evaluation of lymphatic outgrowth is over-staged. Renal insufficiency and anemia are significant decreasing factors on both OS and DFS.

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Publication History

Article published online:
10 June 2020