Cervical node metastases in laryngeal and hypopharyngeal cancer: A prospective analysis of prevalence and distribution

Background. We have prospectively analyzed the prevalence and distribution of histologic cervical node metastases in laryngeal and hypopharyngeal squa mous carcinoma to determine the most appropriate form of neck dissection. Methods. We have examined specimens from 100 consecutive patients in whom n eck dissection was part of the primary treatment of laryngeal and hypophary ngeal carcinoma. Fifty eight patients were treated by unilateral or bilater al selective dissection of levels I to IV +/- VI for NO disease and 42 by c omprehensive dissection for N+ disease. Assessment was by separation of the specimens into node levels at the time of surgery and embedding all the re sected material for histologic analysis. Results. Nodal metastases were found in 36% of ipsilateral and 27% of contr alateral dissections in the NO cases. The corresponding prevalences in N+ c ases were 90% and 37%, respectively. Ail metastases in N0 and N1 disease we re confined to levels II, III, IV, and VI. Metastases to levels I and V wer e infrequent even in N+ disease. Conclusions. Our results support the use of elective dissection of node lev els II to IV for NO laryngeal and hypophalyngeal carcinoma. We suggest the inclusion of level VI nodes for tumors invading the subglottis, pyriform fo ssa apex, and postcricoid region. The prevalence of bilateral metastases is great enough in midline or bilateral tumors to justify bilateral selective dissection. It is possible that selective neck dissection is also adequate for Small palpable metastases, but greater numbers are required to confirm this. (C) 2000 John Wiley & Sons, Inc.