[The importance of the Delphian lymph node in subtotal laryngeal surgery]

Abstract

Objectives: The study was designed to investigate the incidence of the Delphian lymph node in patients who underwent supracricoid laryngectomy (SL) for squamous cell carcinoma of the larynx and to evaluate our surgical approach to the primary tumor and the neck.

Patients and methods: Twenty patients underwent SL for squamous cell carcinoma of the larynx. Laryngeal reconstruction was performed with cricohyoidopexy in 17 patients and cricohyoidoepiglottopexy in three patients. The presence of the Delphian lymph node was evaluated, together with its effect on the surgical technique, tumor metastasis, and prognosis.

Results: Preoperatively, no Delphian lymph nodes were detected by palpation. Intraoperative exploration revealed 13 lymph nodes in eight patients. Histopathologic examination showed metastatic spread in only one patient, the other nodes were found reactive. Surgical resection of the patient with Delphian node metastasis included the perichondrium of the cricoid cartilage as the lowest surgical margin, and neck dissection was extended to include the sixth level and postoperative radiation therapy was administered including the superior mediastinum. The patient died eight months after surgery from lung metastasis and neck recurrence.

Conclusion: Evaluation of the Delphian lymph node existence particularly in patients with tumors involving the anterior commissure, anterior subglottic area, epiglottic petiole, and the pyriform sinus is important in excluding the possibility of leaving metastatic nodes behind in surgical techniques in which partial or total preservation of the cricoid cartilage is considered.