Upper mediastinal and paratracheal node dissection in total (pharyngo) laryngectomy, it is really indicated?

Introduction: Advanced laryngeal and hypopharyngeal cancers are aggressive tumors with a poor prognosis. Multiple lymph node metastases often occur in the neck as well as in the upper mediastinum and thus upper mediastinal dissection is crucial to improving the cure rate. However, excessive mediastinal dissection can increase postoperative morbidity and mortality making it important to employ the proper technique and appropriate extent of dissection. In the present study, we aimed to determine the need and the prognostic importance of mediastinal dissection in patients with advanced carcinoma of the upper aerodigestive tract. Methods: A retrospective review of the records of 30 patients who underwent (pharynxgo) laryngectomy for advanced squamous cell carcinomas was done. 17 patients had laryngeal carcinomas, 13 had hypopharyngeal carcinomas. The mediastinal dissection was designed to remove mainly the paratracheal and retrooesophageal lymph nodes. Results: 60 neck dissections and 30 mediastinal dissection were performed in 30 patients and yielded positive nodes were found in 20/30 patients. Neck nodes were positive in 9/17 of the patients with laryngeal cancer and 11/13 of the patients with hypopharyngeal cancers respectively. Positive nodes were detected in the neck regardless of T stage. The mediastinal nodes were positive in 0% of the patients with laryngeal cancer. Upper mediastinal metastases were detected positive in 6/13 of the hypopharyngeal patients. In these patients, mediastinal metastases were associated with tumors greater than 35 mm. The majority of positive paratracheal nodes were less than 1 cm in diameter and appeared negative preoperatively. 0% of the patients had positive paratracheal nodes alone in a histologically negative cervical neck dissection Regarding the appropriate extent of dissection, no major complications were observed. Conclusions: There is little controversy about neck dissection in advanced tumors of the (pharyngo) larynx. Laryngeal carcinomas showed no positive mediastinal nodes in this series. The study highlighted the propensity of advanced hypopharyngeal cancers to involve the paratracheal nodes.