Fiorella R, Di Nicola V, Fiorella M L, Russo C
Department of Ophthalmology and Otorhinolaryngology, II ENT Unit, University of Bari, Italy.
Acta Otorhinolaryngol Ital. 2006 Dec;26(6):356-9.
It is well known that malignant laryngeal tumours can extend from their site of origin into tributary lymph nodes, depending on their location and size. Management protocols almost always include concomitant surgical treatment of both the tumour and cervical nodes. When palpable lymph nodes are present, dissection is mandatory but there is no general agreement on the option of choice in clinically N0 patients. Elective neck dissection, following the current indications, is necessary in most cases of N0 laryngeal cancer, but the number of bilateral dissections may be limited. In tumours of only one hemilarynx or extending slightly beyond it, metastatic involvement is more likely to be on the same side as the lesion although there is no absolute certainty that it will be. In these cases, and especially in supraglottic tumours, occult metastatic spread may also penetrate into the contralateral lymph nodes of the neck. The present report deals with the results of a surgical strategy to limit bilateral elective dissection, based on the following criteria. In supraglottic tumours of only one hemilarynx or extending slightly beyond it, the presence of ipsilateral node metastases is highly predictive of a concomitant involvement of the contralateral nodes. In these supraglottic tumours, only in cases with post-operative serial positive histology of the uni-ipsilateral dissected cervical lymph nodes, has contralateral elective neck dissection ("conditional dissection") been performed. "Conditional dissections" led to a reduction of approximately 70% of elective bilateral neck dissections.
众所周知，恶性喉肿瘤可根据其位置和大小从原发部位扩展至引流淋巴结。治疗方案几乎总是包括对肿瘤和颈部淋巴结同时进行手术治疗。当可触及淋巴结时，必须进行清扫，但对于临床N0患者的选择尚无普遍共识。按照当前指征，大多数N0喉癌病例需要进行选择性颈部清扫，但双侧清扫的数量可能有限。在仅累及一侧半喉或略微超出该范围的肿瘤中，转移更可能发生在与病变同侧，尽管不能绝对确定。在这些情况下，尤其是声门上肿瘤，隐匿性转移也可能累及对侧颈部淋巴结。本报告基于以下标准，阐述了一种限制双侧选择性清扫的手术策略的结果。在仅累及一侧半喉或略微超出该范围的声门上肿瘤中，同侧淋巴结转移的存在高度预示对侧淋巴结也会受累。在这些声门上肿瘤中，仅在单侧清扫的颈部淋巴结术后组织学检查呈连续阳性的情况下，才进行对侧选择性颈部清扫（“条件性清扫”）。“条件性清扫”使选择性双侧颈部清扫减少了约70%。
