| PrefaceThe problem of the contralateral NO neck is relevant and has a great impact on patients'survival, particularly in supraglottic cancer. Elective treatment of the contralateral NO neck in patients with squa-mous cell carcinoma of the supraglottic larynx remains a complex and controversial issue. We reviewed our experience with patients, who had elective neck dissection for contralateral NO supraglottic squamous carcinoma with occult metastases , in order to compare elective lymph-denectomy results with those achieved with therapeutic neck dissection performed subsequently when occult disease became clinically evident.ObjectiveTo define the risk of contralateral neck metastases in 634 supra-glottic cancer patients, and to retrospectively compare the results ofcontralateral elective neck surgery and a wait - and - see policy in thetreatment of contralateral neck disease.Patients and Methods From a database containing 1699 previously untreated patientswith laiyngeal carcinoma surgically treated at the department of otolar-yngology head and neck surgery of the China Medical University between January 1983 and December 1996, we selected 634 patients with squamous cell carcinoma of the supraglottic larynx . To better analyze the true impact of the risk of contralateral lymph node metasta-ses, we selected from a large series only cases who had no postoperative radiotheraphy after the first surgical procedure. The other criteria for inclusion in this study were the histologic confirmation, after neck dissection, and a 5 - year minimum follow - up. Our study population consisted of 353 men and 281 women, who ranged in age from 37 to 72 years.Each patient was analyzed by site and T - stage according to U-nion International Centre Cancer criteria (1987 ).The patient population was divided into three groups according to different cervical treatment. On the first subset, including 59 patients without neck metastases, all of them were subject to close and regular follow - up, according to a wait - and - see policy. The second group consisted of 286 patients without contralateral neck metastases, all of them had a unilateral neck dissection, as for the contralateral neck also according to the wait - and - see policy. The third group consisted of 289 patients, all of them had a bilateral neck dissection, no matter whether with positive node of the contrlateral neck.In this study, we have retrospectively analyzed clinical, pathologic and follow - up data from a group of 634 supraglottic cancer patients to evaluate the risk of contralateral neck involvement at the time of diagnosis or during follow - up. Moreover, in this series, we studied the efficacy of elective contralateral neck dissection in association with ipsilateral therapeutic lymphadenectomy as opposed to the subse-quent delayed treatment when contrlateral metastases become clinically evident.ResultsThe analysis of our series showed a significantly higher incidence of contralateral neck disease in relation to ipsilateral neck stage. The risk of contralateral neck disease was 34. 51% (78/226) in patients with ipsilateral cervical metastases, compared with 11. 52% (477 408) in those without ipsilateral neck disease.The analysis of T - stage showed an overall increased risk of contralateral or bilateral neck involvement with an increase of tumor size and stage ( figure 2,4).The analysis of lymph node involvement in the ipsilateral showed an overall increased risk of contralateral neck metastasis with an increase of ipsilateral cervical stage ( figure 3 ).The analysis of tumormorphous showed that the ulcerous tumors had the most risk of contralateral neck involvement than the any others ( figure 5 ).Table 6 showed the analysis of contralateral cervical recurrences according to the growth pattern of tumor.The analysis of level distribution of the contralateral neck disease showed that there was not any significant difference between occult and delayed contralateral neck disease.In our series we found out that th... |
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