[Pathological feature and management of occult lymphatic metastasis in supraglottic carcinoma]

Abstract

Objective: To study the pathologic feature and management methods of occult lymphatic metastasis in patients with supraglottic carcinoma.

Methods: The following are criteria of patients selection: (1) Supraglottic squamous cell carcinoma; (2) Clinical N0M0; (3) no preoperative radiotherapy and (or) chemotherapy. Thirty patients were recruited, male 19 cases, female 11; age: 40 - 72yr, average 54.8yr; T2 8 cases, T3 18, T4 4 (by UICC 1997). Ipsilateral supraomohyoid neck dissections were performed in all cases. Lymph nodes were studied histologically according to the levels of dissection.

Results: Six of 30 cases were positive nodes histologically in first operation, 3 were occurrence neck metastasis in opposite side during follow ups. Occult metastasis rate was 20% (6/30) ipsilaterdly and 10% contralaterally. 527 lymph nodes were collected in all of 30 patients, average 17.6 nodes in every side neck. Ten positive lymph nodes histologically were harvested. The distribution of metastatic lymph nodes was 9 in level II, 1 in level III, no in level I. N0 recurrence in larynx and (or) at the neck after dissection. Two years survival rates was 86.7% (26/30) without tumor.

Conclusion: Occult metastasis rate of supraglottic carcinoma is as high as 30%. The selective lateral neck dissection of level II, III and occasionally, level IV was recommended.