Indication of elective contralateral neck dissection in squamous cell carcinoma of the hypopharynx

Abstract

Lymph node metastases (LNM) are common in hypophariyngeal carcinomas; the neck dissection is an important therapeutic approach. AIM: to analyze the incidence and distribution of LNM and failures in treating the contralateral neck. METHODS: a retrospective study of 174 patients with hypopharyngeal cancer treated from 1978 to 2003. The distribution of LNM and regional recurrences were evaluated. RESULTS: 44% of the cases were false negatives and 4.9% were false positives. Among the 48 patients who underwent bilateral ND, 29 had bilateral metastases and one had contralateral metastasis. Contralateral neck recurrences occurred in 12 cases that underwent unilateral ND. Among the nine patients with contralateral neck recurrence alone, eight were surgically salvaged. The risk of contralateral metastases was related to clinical staging (p=0.003) and involvement of the medial wall of the pyriform sinus (p=0.03), but not to radiotherapy (p=0.28). CONCLUSION: Contralateral metastases were more frequent when the medial wall of the pyriform sinus was affected, in the presence of ipsilateral palpable metastases and clinical stage IV.

As metástases linfonodais são frequentes nos carcinomas da hipofaringe e o esvaziamento cervical é parte importante do tratamento. OBJETIVO: Avaliar a incidência e distribuição das metástases linfonodais e as falhas no tratamento do pescoço contralateral. MÉTODOS: Estudo retrospectivo de 174 pacientes com carcinoma epidermoide de hipofaringe tratados entre 1978 e 2003. Foi avaliada a distribuição das metástases linfonodais e as recidivas regionais. RESULTADOS: Foram diagnosticados 44% de casos falso-negativos e 4,9% falso-positivos. Dos 48 pacientes submetidos ao esvaziamento bilateral, 29 apresentaram metástases bilaterais e um apresentou metástase contralateral apenas. As recidivas cervicais contralaterais ocorreram em 12 casos submetidos ao esvaziamento unilateral. Dos 9 pacientes com recidiva cervical contralateral isolada, 8 pacientes foram resgatados cirurgicamente. O risco de metástases contralaterais relacionou-se com o estadiamento clínico (p=0,003) e com o comprometimento da parede medial do recesso piriforme (p=0,03), mas não com a realização de radioterapia (p=0,28). CONCLUSÕES: As metástases contralaterais nos carcinomas da hipofaringe foram mais frequentes quando a parede medial do recesso piriforme estava comprometida, na presença de metástases palpáveis ipsilaterais e estádio clínico IV.

Heliopolis Hospital

Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) course in otorhinolaryngology and head & neck surgery

Heliopolis Hospital Escola Paulista de Medicina course in otorhinolaryngology and head & neck surgery

UNIFESP, EPM, course in otorhinolaryngology and head & neck surgery

Heliopolis Hospital Escola Paulista de Medicina course in otorhinolaryngology and head & neck surgery

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