The importance of the Delphian lymph node in subtotal laryngeal surgery

Year 2003, Volume: 10 Issue: 6, 231 - 236, 24.12.2003

Sinan Kocatürk Şemsettin Okuyucu Ünsal Erkam Fulya Köybaşıoğlu Ayper Kaçar

Abstract

Cbjectives: The study was designed to investigate the incidence of the Delphian lymph node in patients who undervvent supracricoid laryngectomy SL for squamous celi carcinoma of the larynx and to evaluate our surgical approach to the primary tu mor and the neck.Patients and Methods: Twenty patients undervvent SL for squamous celi carcinoma of the larynx. Laryngeal reconstruc- tion 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 post- operative 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 com- missure, anterior subglottic area, epiglottic petiole, and the pyriform sinüs 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.

Keywords

Cricoid cartilage/pathology, laryngeal neoplasms/ surgery, laryngectomy, lymph nodes/pathology, lymphatic metastasis/pathology, neoplasm recurrence, local, prognosis

Subtotal larenks cerrahisinde Delphian lenf nodunun önemi

Abstract

Amaç: Bu çalıflmada, larenkste skuamöz hücreli kansernedeniyle suprakrikoid larenjektomi SL uyguladığımızhastalarda Delphian lenf nodu sıklığı arafltırıldı ve buhastalarda primer tümöre ve boyna yaklaflım değerlendirildi.Hastalar ve Yöntemler: Larenkste skuamöz hücreli tümor nedeniyle 20 hastaya SL uygulandı. Rekonstrüksiyon 17 hastada krikohyoidopeksi, üç hastada krikohyoidoepiglottopeksi tarzında yapıldı. Hastalarda Delphianlenf nodunun varlığı ve bunun cerrahi tekniğe, tümörmetastazına ve prognoza etkisi değerlendirildi.Bulgular: Ameliyat öncesi palpasyonda hiçbir hastadaDelphian lenf nodu bulunmazken, ameliyat sırasında sekiz hastada 13 adet lenf nodu saptandı. Histopatolojik incelemede sadece bir hastada metastaz saptandı; diğerlenf nodlarının reaktif olduğu görüldü. Metastaz bulunanhastada alt cerrahi sınırda krikoid kıkırdak perikondriumu rezeksiyona dahil edildi, boyun diseksiyonu seviyeVI’yı kapsayacak flekilde geniflletildi ve ameliyat sonrasında superior mediasteni de içeren adjuvan radyoterapi uygulandı. Bu hasta sekizinci ayda akciğer metastazıve boyun nüksü nedeniyle yaflamını yitirdi.Sonuç: Özellikle ön komissür, anterior subglottik bölge, epiglot petiolü ve piriform sinus tutulumlu olgularda Delphian lenf nodunun aranması, krikoid kıkırdağıtamamen ya da kısmen koruyan tekniklerde metastazlı lenf nodunun hastada bırakılmaması bakımındanö n e m l i d i r

Keywords

Krikoid kartilaj/patoloji, larenjeal neoplazmlar/cerrahi, larenjektomi, lenf nodu/patoloji, lenfatik metastaz/patoloji, neoplazm nüksü, lokal, prognoz

References

• Saatçi MR, Gerçeker M, Anadolu Y, Kocatürk S, Akbafl Y. Larenks kanserlerinde pozitif Delphian nodu. Türk Otolarengoloji Arflivi 1995;33:239-43.
• Thaler ER, Montone K, Tucker J, Weinstein GS. Delphian lymph node in laryngeal carcinoma: a whole organ study. Laryngoscope 1997;107:332-4.
• Olsen KD, DeSanto LW, Pearson BW. Positive Delphian lymph node: clinical significance in laryn- geal cancer. Laryngoscope 1987;97:1033-7.
• P a ff GH. Lymph nodes and lymphatics of head and neck. In: Anatomy of the head and neck. 1st ed. Philadelphia: W. B. Saunders; 1973. p. 221-9.
• Eibling DE. Neck dissections. In: Myers EN, Carrau RL, Cass SP, Eibling DE, Hirsch BE, Janecka IP, et al. editors. Operative otolaryngology: head and neck surg e r y. Vol. 1, 1st ed. Philadelphia; W.B. Saunders; 1997. p. 676-718.
• Biliciler N, Cevanflir B, Akmandil A, Baflarer N, Kösemen H, Yazıcıoğlu E ve ark. Larenks kanseri TNM sisteminin günümüz koflullarında tartıflılması. In: Türk ORL Derneği XVII. Milli Kongresi Kitabı. İstan- bul: Çeltüt Matbaacılık; 1983. s. 170-3.
• Foote RL, Buskirk SJ, Stanley RJ, Grambsch PM, Olsen KD, DeSanto LW, et al. Patterns of failure after total laryngectomy for glottic carcinoma. Cancer 1989;64: 143-9.
• Modrzejewski M, Sieradzki A, Tomik J, Strek P. The clin- ical significance of metastatic cancer of the larynx to the Delphi node. Otolaryngol Pol 1996;50:156-61. [Abstract]
• Gawlak-Prycka A. Prelaryngeal lymph node (Delphian) in patients with laryngeal cancer. Otolaryngol Pol 2001;55:35-41. [Abstract]
• Tucker HM. Anatomy of the larynx. In: The larynx. 2nd ed. New York: Thieme Medical Publishers; 1993. p. 1-18.
• Kaya S. Larenks kanseri. In: Larenks hastalıkları. 1. baskı. Ankara: Bilimsel Tıp Kitabevi; 2002. s. 539-90.
• Pignotaro LD, Dacomo G, Scovanellini G. Pourier’s node metastasis in the carcinoma of the larynx. In: Sunar O, editors. Proceedings of the XV. Wo r l d Congress of ORL Head and Neck Surgery. Vol. 2, Essex: Multiscience Publishing; 1993. p. 742-3.
• Szmeja Z, Kaczmarek J, Szyfter W, Malinowska B. Metastases in the prelaryngeal (delphian) lymph nodes in the course of the laryngeal cancer. Otolaryngol Pol 1995;49:422-5. [Abstract]
• Tucker HM. Malignant neoplasms. In: The larynx. 2nd ed. New York: Thieme Medical Publishers; 1993. p. 287-323.
• Richard JM, Sancho-Garnier H, Micheau C, Saravane D, Cachin Y. Prognostic factors in cervical lymph node metastasis in upper respiratory and digestive tract car- cinomas: study of 1,713 cases during a 15-year period. Laryngoscope 1987;97:97-101.
• Sessions SB, Hudkings CP. Malignant cervical lym- phadenopaty. In: Cummings CW, Fredrickson JM, Harker LA, Krause CJ, Schuller DE, editors. Otolaryngology head and neck surg e r y. Vol. 2, 2nd ed. St. Louis: Mosby Year Book; 1993. p. 1605-26.
• Robin PE, Oloffson J. Tumors of the larynx. In: Kerr AE, editor. Scott-Brown’s otolaryngology. Vol. 1, 5th ed. London: Butterworths; 1987. p. 202-3.
• Johnson JT, Myers EN. Cervical lymph node disease in laryngeal cancer. In: Silver CE, editor. Laryngeal cancer. New York: Thieme Medical Publishers; 1991. p. 23-26.
• Ferlito A, Shaha AR, Rinaldo A. Prognostic value of Delphian lymph node metastasis from laryngeal and hypopharyngeal cancer. Acta Otolaryngol 2002;122:456-7.
• Laccourreye O, Ross J, Brasnu D, Chabardes E, Kelly JH, Laccourreye H. Extended supracricoid partial laryngectomy with tracheocricohyoidoepiglottopexy. Acta Otolaryngol 1994;114:669-74.
• Laccourreye O, Brasnu D, Jouffre V, Couloigner V, Naudo P, Laccourreye H. Supra-cricoid partial laryn- gectomy extended to the anterior arch of the cricoid with tracheo-crico-hyoido-epiglottopexy. Oncologic and functional results. Ann Otolaryngol Chir Cervicofac 1996;113:15-9. [ A b s t r a c t ]
• Shah JP. Cervical lymph node metastases-diagnostic, therapeutic, and prognostic implications. Oncology 1990;4:61-9.
• Candela FC, Shah J, Jaques DP, Shah JP. Patterns of cer- vical node metastases from squamous carcinoma of the larynx. Arch Otolaryngol Head Neck Surg 1990; 116:432-5.
• Resta L, Micheau C, Cimmino A. Prognostic value of the p relaryngeal node in laryngeal and hypopharyngeal car- cinoma. Tumori 1985;71:361-5.
• Kowalski LP. Noncervical lymph node metastasis from head and neck cancer. ORL J Otorhinolaryngol Relat Spec 2001;63:252-5.
• Rockley TJ, Powell J, Robin PE, Reid AP. Post-laryn- gectomy stomal recurrence: tumour implantation or paratracheal lymphatic metastasis? Clin Otolaryngol 1991;16:43-7.
• Leon X, Quer M, Burgues J, Abello P, Vega M, de Andres L. Prevention of stomal recurrence. Head Neck 1996;18:54-9.
• Hanna EY. Subglottic cancer. Am J Otolaryngol 1994; 15:322-8.
• Hosal IN, Onerci M, Turan E. Peristomal recurrence. Am J Otolaryngol 1993;14:206-8.
• Kocaturk S, Yilmazer D, Onal B, Erkam U, Urunal B. Do m i c rometastases detected with cytokeratin immunoper- oxidase reactivity affect the treatment approach to neck in supraglottic cancers? Otolaryngol Head Neck Surg 2 0 0 3 ; 1 2 8 : 4 0 7 - 11 .