Abstract
Subglottic extension is one of the factors affecting the directions of treatments for patients with glottic cancer. The way in which the tumor involves the subglottic region may limit laryngeal preservation and affects the necessity of paratracheal dissection.
The purpose of this paper is to assess the necessity of paratracheal dissection and also to evaluate how tumors invade deep structures of the larynx as well as the subglottic region.
In this study, a series of 116 cases with glottic squamous cell carcinoma treated at our institution from January 1990 to December 1999 were reviewed. Of those patients, 87 had T2 tumors without paratracheal metastasis. The remainder included 14 patients with T3 tumors and 15 patients with T4 tumors. Paratracheal dissection was indicated for 23 patients (T3 : 8, T4 : 15) and paratracheal metastasis was pathologically confirmed in 4 patients (T3 : 1, T4 : 3).
All the patients with pathological paratracheal metastasis were found to be at Grade 3 or 4 of Yoshino's subglottic extension grading. Based on this result, paratracheal dissection should be applied in patients with Grade 3 or 4 subglottic extension.
Furthermore, pathological study on sections of 23 larynges described above suggested the importance of careful surgical approaches, especially to tumor dominantly involving the posterior portion of the larynx.
