title: Clinical significance of positive Delphian node in supracricoid laryngectomy with cricohyoidoepiglottopexy.
abstract: OBJECTIVE
  A positive Delphian node is known to predict a poor prognosis in laryngeal cancer. To elucidate the clinical significance of positive Delphian node metastasis in supracricoid laryngectomized patients, we conducted a thorough clinical review.
  
  
  METHODS
  We reviewed clinical data from 65 patients who underwent supracricoid laryngectomy with cricohyoidoepiglottopexy; in these patients, the Delphian node was examined by frozen section as a routine process. Incidence, positivity rates and clinical impact of the positive Delphian node were analyzed.
  
  
  RESULTS
  The presence of the Delphian node was detected in 27 of 65 (41.5%) patients; among these 27 patients, 3 (3/65 = 4.6%) were positive for metastasis. Case 1 (pT3N2b) died of lung metastases 32 months after supracricoid laryngectomy with cricohyoidoepiglottopexy. Case 2 (pT4N2c) underwent conversion to total laryngectomy during supracricoid laryngectomy with cricohyoidoepiglottopexy because of unexpected submucosal lymphatic infiltration; this patient is currently alive with disease 23 months after surgery. Case 3 (T3N1) is currently alive without disease 48 months after surgery.
  
  
  CONCLUSIONS
  The positive Delphian node is exclusively encountered in advanced laryngeal cancers and suggests an ominous outcome. Sufficient dissection of the paratracheal and lateral neck nodes is recommended. Delphian node evaluation is advised for all supracricoid laryngectomy surgeries.
authors.affiliation: Department of Otorhinolaryngology, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa 252-0374, Japan. meijin@med.kitasato-u.ac.jp
authors.forename: Meijin
authors.initials: M
authors.lastname: Nakayama
authors.forename: Yutomo
authors.initials: Y
authors.lastname: Seino
authors.forename: Makito
authors.initials: M
authors.lastname: Okamoto
authors.forename: Tetuo
authors.initials: T
authors.lastname: Mikami
authors.forename: Tabito
authors.initials: T
authors.lastname: Okamoto
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Miyamoto
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000556:secondary / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D007825:Laryngectomy; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009333:Neck; D009367:Neoplasm Staging; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies