title: Paratracheal lymph node dissection, in which patients should it be performed?
abstract: OBJECTIVE
  This study aims to evaluate the effect of paratracheal lymph node (PTLN) metastasis on survival in patients with advanced laryngeal and hypopharyngeal cancer.
  
  
  METHODS
  Medical records of advanced laryngeal and hypopharyngeal cancers who underwent surgery between May 1995 and June 2008 were assessed and 78 of the patients (63 males, 15 females; mean age 55±11.3 years; range 25 to 76 years) who has PTLN metastasis were included in this study. The mean follow-up period was 23 months. Fifty-three patients had primary laryngeal cancer, and the remaining 25 patients had primary hypopharyngeal cancer.
  
  
  RESULTS
  Paratracheal lymph node metastasis was detected in eight (15%) of 53 patients with laryngeal carcinoma, six (42%) of 14 patients with postcricoid carcinoma, and one (14%) of seven patients with posterior pharyngeal wall carcinoma. Paratracheal lymph node metastasis was not detected in patients with pyriform sinus carcinoma (n=4). Paratracheal lymph node metastasis was detected in a total of 15 patients, of whom 11 had extranodal spread (ENS). Multivariate analysis showed that the presence of ENS was the most effective prognostic factor on the overall survival (p<0.0005).
  
  
  CONCLUSIONS
  The presence of PTLN metastasis with ENS is an important prognostic indicator on overall survival. We recommend PTLN dissection particularly in patients with advanced laryngeal or hypopharyngeal cancer for histopathological analysis and prognostication because ENS can only be precisely detected by pathological evaluation.
authors.affiliation: Department of Otolaryngology, Medicine Faculty of İstanbul University, 34093 Fatih, Çapa, İstanbul, Turkey. drcomoglu@gmail.com.
authors.forename: Şenol
authors.initials: Ş
authors.lastname: Çomoğlu
authors.forename: Ece
authors.initials: E
authors.lastname: Çomoğlu
authors.forename: Necati
authors.initials: N
authors.lastname: Enver
authors.forename: Eren
authors.initials: E
authors.lastname: Yılmaz
authors.forename: Mehmet
authors.initials: M
authors.lastname: Çelik
authors.forename: Beldan
authors.initials: B
authors.lastname: Polat
authors.forename: Murat
authors.initials: M
authors.lastname: Ulusan
authors.forename: İsmet
authors.initials: İ
authors.lastname: Aslan
authors.forename: Kemal
authors.initials: K
authors.lastname: Değer
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000473:pathology*; D007822:Laryngeal Neoplasms / Q000473:pathology*; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000473:pathology; D018579:Patient Selection; D010610:Pharyngeal Neoplasms / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies