Clinical Significance of Mesenteric Lymph Nodes Detected on Postoperative CT after a Total Pharyngolaryngectomy and Reconstruction with a Jejunal Free Flap

ABSTRACT

PURPOSE: To investigate the clinical significance of mesenteric lymph nodes (MLNs) detected on postoperative CT images after a total pharyngolaryngectomy and reconstruction using a jejunal free flap (TPL-JFF) in patients with advanced carcinoma of the laryngo-hypopharynx. MATERIALS AND METHODS: We recruited 17 patients with available postoperative CT images following a TPL-JFF. The postoperative CT findings of the MLNs for the JFF were evaluated, including the number of MLNs, maximum-axial-diameter, shape, and presence of central necrosis or cortical enhancement, which were compared between the two groups and divided according to the presence or absence of local recurrence. RESULTS: In 16 of 17 patients except for one patient without MSN, an initial postoperative CT image demonstrated the presence of MLNs (mean number, 2; range 1-4) which had a maximal diameter of 18 mm. New or an increased number of MLNs detected on a subsequent follow-up CT examination was found in only two patients with recurrence. However, MLNs in nine patients without recurrence remained unchanged or decreased. Cortical enhancement was found more frequently in all five MLNs of the two patients with recurrence as compared to cortical enhancement in the MLNs (four among 12 MLNs 33%) of patients without recurrence. The other findings remained the same. CONCLUSION: MLNs on postoperative CT images are very common in patients after a TPL-JFF. Although most MLNs are reactive, a new or increased number of MLNs on a subsequent follow-up CT examination should suggest the presence of a local recurrence.