Yoshimoto Seiichi, Kawabata Kazuyoshi
Division of Head and Neck, Cancer Institute Hospital, 1-37-1 Kami-ikebukuro, Toshima-ku, Tokyo 170-8455, Japan.
Auris Nasus Larynx. 2005 Jun;32(2):163-7. doi: 10.1016/j.anl.2004.11.003.
To clarify the efficacy of retropharyngeal (RP) node dissection for hypopharyngeal cancer (HPC). From 1990 to 1997 (Period I), we examined the RP area preoperatively using computed tomography (CT) and magnetic resonance imaging (MRI), and dissected this region during total pharyngolaryngectomy (TPL) when lymph node shadows were identified. From 1998 to 2001 (Period II), we dissected this region during TPL for all patients displaying stage IV HPC or invasion of the oropharyngeal wall. Outcomes were investigated for patients with positive RP nodes identified during TPL or postoperatively. From 1990 to 2001, positive RP nodes were identified in 41 patients during TPL and in 13 patients, postoperatively. These 54 patients represented 14.8% of all patients with HPC in our hospital. Tumors of the pyriform sinus with oropharyngeal invasion and tumors of the posterior wall both displayed high risk of positive RP nodes. Frequencies of RP nodes were: stage I, 3.0%; stage II, 10.3%; stage III, 9.8%; stage IV, 19.2%. Although preoperative imaging revealed positive RP nodes for 32 patients, positive nodes were too small nodes to detect on CT or MRI in nine patients. No significant differences in survival were noted between Periods I and II. However, 11 of the 41 patients with positive RP nodes during TPL survived >2 years without disease, while only one of the 13 patients with positive RP nodes, identified postoperatively, survived >2 years. Patients with positive RP nodes displayed poor local control rate. RP dissection did not improve survival rate.
为阐明下咽癌（HPC）行咽后（RP）淋巴结清扫术的疗效。1990年至1997年（第一阶段），我们术前使用计算机断层扫描（CT）和磁共振成像（MRI）检查RP区域，当发现淋巴结阴影时，在全喉咽切除术（TPL）期间对该区域进行清扫。1998年至2001年（第二阶段），对于所有表现为IV期HPC或口咽壁受侵的患者，在TPL期间对该区域进行清扫。对TPL期间或术后发现RP淋巴结阳性的患者的预后进行了调查。1990年至2001年，在TPL期间有41例患者发现RP淋巴结阳性，术后有13例患者发现阳性。这54例患者占我院所有HPC患者的14.8%。梨状窝伴口咽侵犯的肿瘤和后壁肿瘤均显示RP淋巴结阳性的高风险。RP淋巴结的频率为：I期，3.0%；II期，10.3%；III期，9.8%；IV期，19.2%。虽然术前影像学检查发现32例患者的RP淋巴结阳性，但有9例患者的阳性淋巴结太小，在CT或MRI上无法检测到。第一阶段和第二阶段之间在生存率方面未发现显著差异。然而，在TPL期间RP淋巴结阳性的41例患者中有11例存活超过2年且无疾病，而术后发现RP淋巴结阳性的13例患者中只有1例存活超过2年。RP淋巴结阳性的患者局部控制率较差。RP清扫术未提高生存率。
