Clinical application of modified neck lymph node dissection to patients with supraglottic laryngeal carcinoma / 中国耳鼻咽喉头颈外科

ABSTRACT

Objective:To evaluate the effects of modified neck dissection (MND)preserving jugular vein on patients with supraglottic laryngeal carcinoma,the clinical data of 88 cases were analyzed retrospectively.Methods:There were 48 males and 40 females,ranging in age from 37 to 72 years old who were diagnosed supraglottic laryngeal squamous cell carcinoma.The clinical stages were T18,T2 30,T3 28,T4 22,cN1 38,cN2 48,cN3 2;pN0 11,pN1 21,pN2 54 and pN3 2,respectively.Among 146 lateral neck dissections in 88 cases (bilateral 58 cases,one lateral 30 cases),106 were MND,40 being radical neck dissections (RND).Of 106 MND,64 were simultaneously performed bilateral neck dissections (18 cases preserved bilateral jugular veins,14 cases preserved on side jugular veins),52 subsequently bilateral neck dissections(first time was RND ,and the second time was all MND).One side MND was performed in 30 cases,which preserved jugular veins.Results:The 3-year survival rate was 81.5%(22/27)in the simultaneous bilateral neck dissection,60.9%(14/23)in the subsequent neck dissection,75.0%(15/20)in the one lateral neck dissection.The 5-year survival rate was 61.5%(16/26),40.9%(9/22),70.6%(12/17)respectively.The recurrent rate of lymph node postoperative was 12.9%(11/85)in the lymph node less than 3cm in diameter,47.6%(10/21)more than 3cm in diameter.The recurrent rate of lymph node was 22.5%(9/40)in the group of RND,19.8%(12/106)in the group of MND.Conclusions:Because the neck lymph node metastasis often occurred in supraglottic carcinoma,the bilateral neck dissection is necessary during which one side jugular vein must be preserved.Results suggested that if the metastasis lymph node was less than 3cm in diameter and had not adhered to jugular vein,the jugular vein should be preserved,which could lesson complications and get better life quality.