2021 Volume 114 Issue 11 Pages 869-874
Background and Purpose: Advanced hypopharyngeal cancer patients with lymph node metastases exhibit a poor prognosis. In particular, evaluation and management of metastatic retropharyngeal lymph nodes (Rouviere’s lymph nodes), which are known to influence the patients’ outcome, are quite difficult. In order to potentially circumvent these issues, at our department, we routinely perform bilateral dissection of Rouviere’s lymph nodes in all advanced hypopharyngeal cancer patients undergoing total pharyngolaryngoesophagectomy (TPLE) and radical neck dissection including those with and without imaging findings suggestive of metastasis in these lymph nodes. We conducted this retrospective study to examine the effectiveness of routine bilateral Rouviere’s lymph node dissection for potentially preserving Rouviere’s lymph node metastasis in patients with advanced hypopharyngeal cancers.
Materials and Methods: The subjects were a total of 51 patients of advanced hypopharyngeal cancer who had undergone Rouviere’s lymph node dissection between 2009 and 2018. The presence/absence of Rouviere’s lymph node metastases was examined in preoperative CT, MRI, and FDG-PET images obtained for subsite localization and staging of the tumors. We compared the results of preoperative image evaluation and postoperative examination of resected specimens for metastatic lesions in the nodes.
Results: Postoperative histopathological examination of the resected specimens revealed metastases in Rouviere’s lymph nodes in 12 out of the 51 patients. In only 3 out of these 12 patients with metastatic lesions in the Rouviere’s lymph nodes were the metastases suspected form the preoperative imaging findings. The 3-year overall survival rate was 72.7% in patients with metastases in Rouviere’s lymph nodes, and 79.3% in those without metastases in this group of nodes. The 5-year overall survival rate was 41.5% in the patients with metastases in Rouviere’s lymph nodes and 74.0% in those without metastases in this group of lymph nodes. No postoperative recurrence was detected in any of the cases.
Conclusions: These results suggest that in patients with advanced hypopharyngeal cancers, performance of bilateral retropharyngeal lymph node (Rouviere’s lymph nodes) dissection would appear to be useful to obtain a better prognosis.
