The importance of the Delphian lymph node in subtotal laryngeal surgery

Yıl 2003, Cilt: 10 Sayı: 6, 231 - 236, 24.12.2003

Sinan Kocatürk Şemsettin Okuyucu Ünsal Erkam Fulya Köybaşıoğlu Ayper Kaçar

Öz

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.

Anahtar Kelimeler

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

Subtotal larenks cerrahisinde Delphian lenf nodunun önemi

Öz

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

Anahtar Kelimeler

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

Kaynakça

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