title: Paratracheal lymph node dissection during laryngectomy after previous (chemo)radiotherapy: a retrospective analysis of complications and histopathological results.
abstract: OBJECTIVE
  To evaluate complications and histopathological results of paratracheal lymph node dissection (PTLND) at laryngectomy after (chemo)radiotherapy.
  
  
  METHODS
  In a retrospective analysis, complications and histopathological results of paratracheal lymph node dissections were analysed in 191 patients with a recurrent or second primary laryngeal or hypopharyngeal carcinoma following radiotherapy with or without chemotherapy.
  
  
  METHODS
  The percentage of complications in patients with bilateral, unilateral or without PTLND.
  
  
  RESULTS
  Forty-seven patients underwent laryngectomy with bilateral paratracheal lymph node dissection, 52 with unilateral and 92 without paratracheal lymph node dissection. Although the difference in total complications was not significant, significantly more fistulae developed in patients with bilateral paratracheal lymph node dissection (40%versus 22%; P =0.016). In multivariate analysis, this difference maintained significant (P = 0.038). Pathological examination of the lymph node dissection specimen showed tumour in 3 of the 96 ipsilateral dissections (3%) and in 1 of the 50 contralateral dissections (2%). This suggests that if unilateral instead of a bilateral paratracheal lymph node dissection had been performed, 17% less fistulae would have occurred in this group of patients, while paratracheal lymph node (PTLN) metastases would have been missed in one patient. Three of four patients with paratracheal lymph nodeparatracheal lymph node metastases had glottic carcinoma, all with subglottic extension.
  
  
  CONCLUSIONS
  Because of the low incidence of lymph node metastases and the increased risk of fistulae, there is a need for a strict selection of patients who need a bilateral paratracheal lymph node dissection at laryngectomy after previous (chemo)radiotherapy.
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands. r.bree@vumc.nl
authors.forename: L
authors.initials: L
authors.lastname: van der Putten
authors.forename: R
authors.initials: R
authors.lastname: de Bree
authors.forename: D J
authors.initials: DJ
authors.lastname: Kuik
authors.forename: P
authors.initials: P
authors.lastname: Doornaert
authors.forename: S E J
authors.initials: SE
authors.lastname: Eerenstein
authors.forename: C R
authors.initials: CR
authors.lastname: Leemans
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000628:therapy*; D005260:Female; D006801:Humans; D007011:Hypoparathyroidism / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D007012:Hypopharyngeal Neoplasms / Q000473:pathology / Q000628:therapy*; D007037:Hypothyroidism / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D015994:Incidence; D007825:Laryngectomy / Q000009:adverse effects* / Q000379:methods; D008197:Lymph Node Excision / Q000009:adverse effects* / Q000379:methods; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands / Q000453:epidemiology; D014132:Trachea