Delphian lymph node in glottic carcinoma subjected to supracricoid partial laryngectomy with cricohyoidoepiglottopexy

Kuauhyama Luna-Ortiz; Adalberto Mosqueda-Taylor

2005, Number 1

<< Back Next >>

Cir Cir 2005; 73 (1)

Delphian lymph node in glottic carcinoma subjected to supracricoid partial laryngectomy with cricohyoidoepiglottopexy

Luna-Ortiz K, Mosqueda-Taylor A

Full text

How to cite this article

Language: Spanish
References: 18
Page: 7-10
PDF size: 42.23 Kb.

ABSTRACT

Introduction: Metastases to Delphian lypmph node is rarely present in laryngeal malignancy. This report describes its frequency in patients with glottic cancer undergoing supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP).
Material and methods: Fourteen patients (13 male and 1 female) with a mean age of 58 years underwent a SCPL with CHEP and functional bilateral neck dissection (levels II-V) searching for the Delphian lymph node. Four patients were in stage I, five in stage II, four in stage III, and one in stage IV. Surgical margins and Delphian lymph nodes were searched for in each partial laryngectomy sample.
Results: The mean follow-up was 9 months. The right-side dissection yielded an average of 18 lymph nodes and the left-side dissection yielded an average of 22 lymph nodes, with no metastatic disease on the ultimate examination. Only one patient (7%) revealed a carcinoma-positive Delphian lymph node, and 6 months later a metastatic lymph node was found on the same side as the primary tumor. The patient underwent standard radiation therapy (66 Gy) targeted to larynx and lymph node areas, as well as to the supraclavicular region (20 Gy).
Discussion: Bilateral functional dissection is indicated in the presence of Delphian lymph node metastatic spread. Post-operative radiation therapy may occasionally be used as an adjuvant treatment in cases with positive Delphian lymph node in spite of a negative functional dissection in partial laryngectomies due to other possible node spread routes. Bilateral functional dissection should be chosen based on tumor site and size.

REFERENCES

1. Olsen KD, DeSantos LW, Pearson BW. Positive Delphian lymph node: clinical significance in laryngeal cancer. Laryngoscope 1987; 97:1033-1037.
2. DeSantos LW, Devine KD, Lillie JC. Cancers of the larynx: glottic cancer. Surg Clin North Am 1977;57:611-620.
3. American Joint Committee on Cancer. Larynx. In: Fleming ID, Cooper JS, Henson DE, Hutter RV, Kennedy BJ, Murphy GP, O’Sullivan B, Sobin LH, Yarbro JW, eds. AJCC Cancer Staging Manual. 5th ed. Philadelphia: JB Lippincott; 1988. pp. 41-46.
4. Filipowski M, Kurnicki W, Sieskiewicz A. Management of lymph node metastases in larynx surgery with organ preservation. Oto-laryngol Pol 2000;54:140-141.
5. Hay ID, Grant CS, Taylor WF, McConahey WM. Ipsilateral lobectomy versus bilateral resection in papillary thyroid carcinoma: a retrospective analysis of surgical outcome using a novel prognostic scoring system. Surgery 1987;102:1088-1095.
6. Johnson JT, Myers EN, Hao SP, Wagner RL. Outcome of open surgical therapy for glottic carcinoma. Ann Otol Rhinol Laryngol 1993;102:752-755.
7. Piquet JJ, Chevalier D. Subtotal laryngectomy with crico-hyoido-epiglotto-pexy for the treatment of extended glottic carcinomas. Am J Surg 1991;162:357-361.
8. Bocca E, Calearo C, de Vincenttis I, Marullo T, Motta G, Ottaviani A. Occult metastases in cancer of the larynx and their relationship to clinical and histological aspects of the primary tumor: a four year multicentric research. Laryngoscope 1984;94:1086-1090.
9. Vincenttis M, Minni A, Gallo A, Di Nardo A. Supracricoid partial laryngectomies: oncologic and functional results. Head Neck 1998;20:504-509.
10. Candela F, Shah J, Jacques D, Shah J. Patterns of cervical node metastasis for squamous carcinoma of the larynx. Arch Otolaryngol Head Neck Surg 1990;116:432-435.
11. McGayran M, Bauer W, Ogura J. The incidence of cervical lymph node metastasis from epidermoid carcinoma of the larynx and their relationship to certain characteristics of the primary tumors. Cancer 1961;14:55-66.
12. Thaler ER, Montone K, Tucker J, Weinstein GS. Delphian lymph node in laryngeal carcinoma: a whole organ study. Laryngoscope 1997;107:332-334.
13. 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;49:422-425.
14. Modrzejewski M, Sieradzki A, Tomik J, Strek P. The clinical significance of metastatic cancer of the larynx to the Delphi node. Oto-laryngol Pol 1996;50:156-166.
15. Gawlak-Prycka A. Prelaryngeal lymph node (Delphian) in patients with laryngeal cancer. Otolaryngol Pol 2001;55:35-41.
16. Resta L, Micheau C, Cimmino A. Prognostic value of the prelaryngeal node in laryngeal and hypopharyngeal carcinoma. Tumori 1985; 71:361-365.
17. Laccourreye O, Hans S, Borzog-Grayelli A, et al. Complications of postoperative radiation after partial laryngectomy in supraglottic carcinoma-a long-term evaluation. Otolaryngol Head Neck Surg 2000;122:752-757.
18. Jackson C. Laryngofissure and laryngectomy for cancer of the larynx. Trans Am Laryngol Soc 1939;61:121-131.