Elective Transcervical Superior Mediastinal Lymph Node Dissection For Advanced Laryngeal and Level 4 N3 Squamous Cell Carcinoma

Authors

  • Lance E. Oxford MD,

    1. Department of Otolaryngology—Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
    2. Division of Otolaryngology and Facial Plastic Surgery, John Peter Smith Hospital, Fort Worth, Texas, U.S.A.
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  • Yadranko Ducic MD, FRCS(C), FACS

    Corresponding author
    1. Department of Otolaryngology—Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
    2. Division of Otolaryngology and Facial Plastic Surgery, John Peter Smith Hospital, Fort Worth, Texas, U.S.A.
    • Dr. Y. Ducic, Director, Otolaryngology and Facial Plastic Surgery, John Peter Smith Hospital, 1500 South Main Street, Fort Worth, Texas 76104.
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Abstract

Objectives: To review our results with elective superior mediastinal lymph node dissections in patients with advanced laryngeal squamous cell carcinoma (SCCA) and overt level 4 adenopathy.

Study Design: Retrospective review.

Methods: We searched operative case logs for all patients treated with an elective superior mediastinal dissection by the senior author (Y.D.) during a 7-year period. Charts were reviewed for demographic information, prior treatment with chemotherapy or radiotherapy, and pathologic results.

Results: Fifty-six patients who underwent elective superior mediastinal lymph node dissection for advanced laryngeal SCCA and overt level 4 adenopathy were reviewed, and superior mediastinal disease was present in 15 of 56 (26.8%) patients. Superior mediastinal nodes were positive in 11 of 42 (26.2%) patients with advanced laryngeal SCCA and 4 of 14 (28.6%) patients with N3 SCCA involving level 4. Patients with SCCA receiving prior chemotherapy and radiotherapy had a significantly higher rate of positive superior mediastinal nodes (10/21 patients, 47.6%) compared with patients without prior therapy (5/35 patients, 14.3%, P = .01, Fisher's exact test). There were no stomal recurrences in 42 patients treated for advanced laryngeal cancer.

Conclusions: Elective transcervical superior mediastinal dissection was positive in 26.8% of patients with advanced laryngeal cancer or N3 disease in level 4. A transcervical superior mediastinal dissection may be safely performed without a sternotomy.

Ancillary