Impact of retropharyngeal lymph node dissection in the surgical treatment of hypopharyngeal cancer
Impact of retropharyngeal lymph node dissection in the surgical treatment of hypopharyngeal cancer
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DOI：
10.1002/hed.25608
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发表时间：
2019-06-01
影响因子：
2.9
通讯作者：
Nibu, Ken-ichi
中科院分区：
文献类型：
--
作者：
Teshima, Masanori;Otsuki, Naoki;Nibu, Ken-ichi
目的探讨咽后淋巴结清扫在下咽癌外科治疗中的作用。方法2007年至2016年，98例未经治疗的病理诊断下咽鳞状细胞癌患者在科比大学医院接受了全咽喉切除术和双侧颈淋巴结清扫术。所有患者均同时行双侧RPLN分离。其中94例采用游离空肠移植行咽部重建，4例一期闭合。术后放化疗的高危因素包括转移到RPLN，多个淋巴结转移，淋巴结浸润，和/或积极/关闭手术切缘的患者进行。结果随访1~105个月，中位随访25个月。9例患者术前在FDG-正电子发射断层扫描中发现RPLN腺病。所有患者均经病理诊断为RPLN转移，在观察期间所有患者均得到控制。其余89例患者中，7例有RPLN转移。有和无RPLN转移患者的2年总生存率分别为65.7%和69.8%（P = 0.61）。结论在本研究中，与无RPLN转移的患者相比，RPLN转移的患者显示出同样有利的肿瘤学结局。对于晚期下咽癌和多个颈淋巴结转移的患者，无论其原发部位在哪，至少应考虑切除同侧RPLN。
Objectives To evaluate the impact of retropharyngeal lymph node (RPLN) dissection in the surgical treatment of hypopharyngeal cancer. Methods Between 2007 and 2016, 98 previously untreated patients with pathological diagnosed hypopharyngeal squamous cell carcinoma underwent total pharyngolaryngectomy and bilateral neck dissection at Kobe University Hospital. Bilateral dissection of RPLN was simultaneously performed in all patients. Pharynx was reconstructed with free jejunal transfer in 94 patients and primarily closed in 4 patients. Postoperative chemoradiotherapy was performed in patients with high risk factors including metastasis to RPLN, multiple lymph node metastasis, extranodal invasion, and/or positive/close surgical margins. Results The median follow-up period was 25 months ranging from 1 to 105 months. RPLN adenopathy was preoperatively identified in 9 patients in FDG-positron emission tomography. All of them had pathologically diagnosed RPLN metastases, which had been controlled in all patients during the observation periods. Among the other 89 patients, 7 patients had RPLN metastasis. The 2-year overall survival rates of the patients with and without RPLN metastasis were 65.7% and 69.8% (P = .61), respectively. Conclusions In the present study, patients with RPLN metastasis showed equally favorable oncological outcome compared with patients without RPLN metastasis. At least, ipsilateral RPLN dissection should be considered in the surgical treatment of advanced hypopharyngeal cancer and multiple neck lymph node metastasis regardless of primary subsite.