Modified neck dissections--efficiency of surgical treatment and clinical observations

The evaluation of affected lymph node number, the site of metastatic lymph nodes, and spread of neoplastic infiltration beyond the lymph capsule is considered useful in prognosis. The aim of the study was to estimate the frequency of neck nodal metastases occurrence depending on the site of origin, the grade of larynx cancer progression, and clinical condition of neck lymph nodes.

The study comprised 315 patients with larynx cancer who underwent surgery in 1994-1999. Laryngectomy was the most frequent procedure, performed in 254 patients, while partial laryngectomy was performed in 61 patients. There were 630 bilateral neck dissections; type I of modified radical surgery in 27 cases, type II in 45 cases, and type III in 558 cases.

Neck nodal metastases were detected most rarely in cases of glottic cancer (16%), and most frequently in transglottic cancer (56%). Most frequently, the nodal metastases affected the II level of the lymph node groups regardless of the site. Recurrences to the neck lymph nodes were observed in 3.3% of the cases where the removed lymph nodes did not reveal any metastatic changes in histopathological examinations.

Postoperative results of the neck lymph node histopathological examination point to the necessity of lymphadenectomy in the II-V levels. Selective lymphadenectomy is not advisable due to the possibility of metastases to all levels of the neck lymph nodes regardless of the primary tumor site.