Background: Identification of occult nodal metastasis is an important
determinant for staging and prognosis, particularly for adjuvant
treatment modalities in head and neck cancer. Objectives: to analyze
the lymph node yield after elective (selective neck dissection level IIIV) for advanced glottic carcinoma with clinically negative neck and
correlate this with early post-surgical outcomes. Patient and
methods: This is a case series study conducted on thirty (30)
consecutive candidates for total laryngectomy at Otolaryngology
departments of both Benha and Tanta University hospitals. Elective
bilateral selective neck dissection SND (II-IV) was done in 18 patients
(60%).Unilateral SND (II-IV) was done 12 patients (40%). Results:
The mean for level II was 9.1, for level III: 11.5 and for level IV: 6.2.
The mean nodal yield of SND (II–IV) is 47.7 LNs (range 12-99).
There is high significance association between lymph node yield and
age (p value=0.001) and with the need of postoperative radiotherapy
(p value =0.031). Intraoperative complication; internal jugular vein
injured in one case (3.33%). There is significant association between postoperative
complications and patient's age (p value = 0.032 ), preoperative tracheostomy (p value =0.002),
side of neck dissection (p value =0.004), positive lymph nodes in level II dissection (p value
=0.005) and overall total size of the tumor (p value =0.033) when overall total tumor size
exceeds 20 cm3
. Conclusion: Lymph node yield and ratio directly influence the prognosis and
postoperative outcomes and could be considered in staging of those patients. |
