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Published on: September 11, 2021
Upper mediastinal node dissection for hypopharyngeal and cervical esophageal carcinomas
Shigeru Hirano1, Kunihiko Nagahara, Sueyoshi Moritani
1Department of Otolaryngology-Head and Neck Surgery, Kyoto University Graduate School of Medicine, Sakyo-ku, Japan.
The Annals of Otology, Rhinology, and Laryngology
|May 12, 2007
Summary
Upper mediastinal dissection (MD) is crucial for hypopharyngeal and cervical esophageal cancers. This study found MD provides excellent control with rare complications, suggesting its necessity for specific cancer stages.
Area of Science:
- Oncology
- Surgical Oncology
- Thoracic Surgery
Background:
- Hypopharyngeal cancer (HPC) and cervical esophageal cancer (Ce) are aggressive, often metastasizing to the upper mediastinum.
- Upper mediastinal dissection (MD) is vital for improving cure rates but carries risks.
- Determining the optimal extent of MD based on tumor characteristics is essential.
Purpose of the Study:
- To determine the appropriate extent of upper mediastinal dissection (MD) for hypopharyngeal cancer (HPC) and cervical esophageal cancer (Ce).
- To evaluate the benefits and risks of upper MD in relation to tumor site and stage.
- To assess the impact of upper MD on survival and locoregional control.
Main Methods:
- Retrospective chart review of patients undergoing upper MD.
- Inclusion of 64 HPC, 21 Ce, and 9 Ce extending to the upper thoracic esophagus (Ce/Ut) patients.
- Assessment of lymph node metastasis incidence, distribution, postoperative complications, survival, and locoregional control.
Main Results:
- Upper mediastinal metastases occurred in 7.8% of HPC, 33.3% of Ce, and 55.6% of Ce/Ut patients.
- Metastases in HPC were linked to T4 tumors; in Ce/Ce/Ut, they occurred regardless of T stage.
- 5-year survival rates ranged from 38.9% to 58.6%, locoregional control from 77.7% to 94.1%, with a 5.3% rate of major vascular complications.
Conclusions:
- Upper MD achieves excellent locoregional control with a low incidence of severe complications.
- Upper MD is recommended for Ce and Ce/Ut tumors.
- Upper MD may be necessary for T4 HPC to enhance locoregional disease control.
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