On the radical neck dissection for metastasis to the cervical lymph nodes of the malignant tumor in the field of otorhinolaryngology

Abstract

With reference to 60 cases of malignant tumor in the field of otorhinolaryngology, which were treated in our clinic from 1957 to 1959, the feature of metastasis to the cervical lymph nodes was pathohistologically examined by the author. Hitherto, the cervical lymph nodes have been assumed to be an area with a predilection for recurrence after total laryngectomy carried out under the diagnosis of malignant tumor in the field of otorhinolaryngology.
With regard to the radical neck dissection as a method of preventing and treating the metastasis to the cervical lymph nodes, the author has made a pathohistological study by tumor group, making clear its significance as well as the feature of metastasis of each group of tumors. Add to this, the postoperative results were referred to.
1) In patients without clinically palpable cervical lymph nodes, who were submitted to a prophylactic neck dissection with the removal of malignant tumor, microscopically positive nodes were found in 12 out of 34 cases (35.2%). According to this pathohistological fact, the prophylactic neck dissection with laryngectomy must be performed even in case of no palpable nodes, in order to prevent the recurrence of the disease in the cervical lymph nodes.
2) In patients with clinically palpable cervical lymph nodes, the metastasis of malignant tumor to the cervical lymph nodes was microscopically proved to be negative in 5 out of 26 cases of therapeutic neck dissection (19.2%). The metastatic tumor had perforated through the capsule of lymph nodes, and invaded the adipose tissue around them. Therefore, in order to prevent the recurrence of the disease in the cervical lymph nodes, the combined radical neck dissection with laryngectomy must be performed in all patients with clinically palpable cervical lymph nodes, because the exstirpation of lymph nodes only of up to this day seems to be insufficient.
3) Regarding the cancerous growth, the frequency of metastasis to the lymph nodes in case of prophylactic neck dissection was as follows: cancer of the tongue 1 case (100%), cancer of the larynx 5 out of 15 cases (33.3%), cancer of the upper jaw 5 out of 15 cases (33.3%), while in cases of cancer of the lower jaw, cheek and palate there was microscopically no metastasis observed.
4) Regarding the cancerous growth, the frequency of metastasis to the lymph nodes in case of therapeutic neck dissection was as follows: cancer of the larynx 9 cases (100%), cancer of the upper jaw 1 case (100%), cancer of the tongue 1 case (100%), cancer of the pharynx 1 case (100%), cancer of the cervical part of esophagus 2 out of 4 cases (50%) and cancer of the palate 0 case (0%). As for the. sarcoma, the frequency of metastasis in this case was as follows: sarcoma of the upper pharynx 1 case (100%), sarcoma of the middle pharynx 2 cases (100%), sarcoma of the lower pharynx 2 cases (50%) and sarcoma of the upper jaw 1 case (0%).
5) Six years and four months have passed since the radical neck dissection and hyopreepiglolaryngectomy (IWAMOTO) were adopted by us for the first time, during which, in comparison with the past results, we have been making a fine record in operation with the recurrence rate of 16.9% and with the death rate of 10.3%.
6) Not only in the presence of a high-degree cancer infiltration into the oral and pharyngeal cavity in case of cancer of the upper jaw, but also in case that there is any doubt of the infiltrative proliferation of cancer into the orbit, the prophylactic neck dissection must be performed, when the patient is in a more advanced stage of cancer infiltration than an early stage.
7) In case of a high-degree external cancer (cancer of the larynx) as well as of a high-degree cancer of the lower pharynx and esophagus, I should like to emphasize the radical neck dissection on both sides of the neck.