Department of Otorhinolaryngology, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa 252-0374, Japan.
Jpn J Clin Oncol. 2011 Aug;41(8):987-91. doi: 10.1093/jjco/hyr091. Epub 2011 Jun 29.
A positive Delphian node is known to predict a poor prognosis in laryngeal cancer. To elucidate the clinical significance of positive Delphian node metastasis in supracricoid laryngectomized patients, we conducted a thorough clinical review.
We reviewed clinical data from 65 patients who underwent supracricoid laryngectomy with cricohyoidoepiglottopexy; in these patients, the Delphian node was examined by frozen section as a routine process. Incidence, positivity rates and clinical impact of the positive Delphian node were analyzed.
The presence of the Delphian node was detected in 27 of 65 (41.5%) patients; among these 27 patients, 3 (3/65 = 4.6%) were positive for metastasis. Case 1 (pT3N2b) died of lung metastases 32 months after supracricoid laryngectomy with cricohyoidoepiglottopexy. Case 2 (pT4N2c) underwent conversion to total laryngectomy during supracricoid laryngectomy with cricohyoidoepiglottopexy because of unexpected submucosal lymphatic infiltration; this patient is currently alive with disease 23 months after surgery. Case 3 (T3N1) is currently alive without disease 48 months after surgery.
The positive Delphian node is exclusively encountered in advanced laryngeal cancers and suggests an ominous outcome. Sufficient dissection of the paratracheal and lateral neck nodes is recommended. Delphian node evaluation is advised for all supracricoid laryngectomy surgeries.
已知 Delphian 淋巴结阳性可预测喉癌预后不良。为了阐明环状软骨上喉切除术患者中 Delphian 淋巴结转移的临床意义，我们进行了详细的临床回顾。
我们回顾了 65 例行环状软骨上喉切除术和环舌会厌固定术的患者的临床资料；在这些患者中，常规进行 Delphian 淋巴结冷冻切片检查。分析了阳性 Delphian 淋巴结的发生率、阳性率和临床影响。
65 例患者中，27 例（41.5%）存在 Delphian 淋巴结；其中 3 例（3/65=4.6%）为转移性阳性。病例 1（pT3N2b）在环状软骨上喉切除术和环舌会厌固定术后 32 个月死于肺转移。病例 2（pT4N2c）在环状软骨上喉切除术和环舌会厌固定术期间因意外粘膜下淋巴管浸润而转为全喉切除术；该患者在手术后 23 个月仍患有疾病，但仍存活。病例 3（T3N1）在手术后 48 个月无疾病，仍存活。
阳性 Delphian 淋巴结仅见于晚期喉癌，提示预后不良。建议充分解剖气管旁和侧颈部淋巴结。建议对所有环状软骨上喉切除术进行 Delphian 淋巴结评估。
