Jaiswal Avinash Shekhar, Bollu Sumanth, Budhiraja Shilpi, Kaushal Seema, Sikka Kapil, Thakar Alok, Verma Hitesh
Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
Turk Arch Otorhinolaryngol. 2023 Mar;61(1):20-24. doi: 10.4274/tao.2023.2023-2-12. Epub 2023 Aug 11.
To evaluate bilateral superior and recurrent laryngeal nerves for tumor spread in patients of advanced-stage laryngeal carcinoma undergoing surgical resection.
A prospective study was conducted including biopsy-proven cases of laryngeal squamous cell carcinoma (SCC) that were planned for total laryngectomy. Patients with metachronous or synchronous SCC were excluded from the study. All patients underwent total laryngectomy, where both superior and recurrent laryngeal nerves were harvested along with the specimen, and the proximal ends of the nerves were marked for reference. Perineural invasion (PNI) was assessed in nerves within the tumor and in bilateral extra-laryngeal nerves.
The study included 22 patients with a mean age of 58 years. Intra-tumoral PNI was found in 7 of the 22 cases (32%). The free nerve margins of superior and recurrent laryngeal nerves, which were examined from proximal to distal orientation, showed no tumor infiltration in any of the cases.
Perineural invasion of minor nerves constitutes a major pathway of spread. On the contrary, invasion of superior or recurrent laryngeal nerves does not constitute a route for tumor spread. Hence, there is no need to extend the surgical boundary for total laryngectomy to include these major nerves separately.
评估晚期喉癌患者在接受手术切除时双侧喉上神经和喉返神经的肿瘤扩散情况。
进行一项前瞻性研究，纳入经活检证实计划行全喉切除术的喉鳞状细胞癌（SCC）病例。异时性或同时性SCC患者被排除在研究之外。所有患者均接受全喉切除术，术中在切除标本时一并获取喉上神经和喉返神经，并标记神经近端以供参考。评估肿瘤内神经及双侧喉外神经的神经周围浸润（PNI）情况。
该研究纳入22例患者，平均年龄58岁。22例中有7例（32%）发现肿瘤内PNI。从近端向远端检查的喉上神经和喉返神经的游离神经边缘在所有病例中均未显示肿瘤浸润。
小神经的神经周围浸润是主要的扩散途径。相反，喉上神经或喉返神经的浸润并非肿瘤扩散途径。因此，全喉切除术无需扩大手术边界以单独包括这些主要神经。
