Ferit KARA, Muzaffer KANLIKAMA, Tekin BAĞLAM, Cengiz ÇEVİK, Engin ŞENGÜL, Cemile ŞENGÜL ARIKAN, Zeynel A. KARATAŞ

Larenks kanserlerinde, servikal metastaz sıklığı ile tümöre ait faktörlerin ilişkisi ve bu olguların cerrahi tedavi sonuçları 6

Amaç: Çalışmamızda larenkste tespit edilen primer tümörün lokalizasyonu, büyüklüğü, evresi, histopatolojik diferansias- yon derecesi, tutmuş olduğu anatomik yapı ile boyun metas- tazı arasındaki ilişkisi ve tümörün evresinin sağkalım üzerine olan etkisini araştırdık. Gereç ve yöntem: Kliniğimizde 2000-2010 yılları arasında larenks kanseri nedeniyle primer tedavi olarak cerrahi (total veya parsiyel larenjektomi) uygulanmış olan, gerektiğinde boyun diseksiyonu yapılan ve gerektiğinde postoperatif rad- yoterapi uygulanan 333 hastanın dosyaları incelendi. Hasta- ların yaşı, cinsiyeti, tümörün lokalizasyonu, tümörün büyük- lüğü, tümörün evresi, histopatolojik diferansiasyon derecesi, preoperatif pozitif lenf nodu bulunup bulunmadığı, yapılan ameliyatlar, ameliyat bulguları ve postop spesmenin histopa- tolojik değerlendirme sonuçları retrospektif olarak incelendi. Bulgular: Tümörün yerleşim bölgesine göre; vakaların 172’si (%51.6) glottik, 108’i (%32.4) supraglottik, 53’ü (%15.9) ise transglottik yerleşimliydi. Glottik tümörlerde %18.6 oranında servikal metastaz, %11 oranında occult metastaz tespit edilir- ken, supraglottik tümörlerde %45.3 oranında servikal metas- taz, %24 oranında occult metastaz tespit edildi. Transglottik tümörlerde ise %49 oranında servikal metastaz, %22.6 ora- nında occult metastaz tespit edildi. 333 hastanın 41’i (%12.3) postoperatif nüks etti. Ayrıca 333 hastanın 111’ine de posto- peratif radyoterapi önerildi. Sağkalım oranı 50. ayda %75,4 ve kümülatif sağkalım oranı %68,9 olarak tespit edildi. Sonuç: Sonuç olarak, optimal tedavinin tartışmalı olduğu, N0 larenks kanserlerinde yüksek occult metastaz riski düşünülen durumlarda, tümörün anatomik olarak yerleşim yerine göre unilateral veya bilateral elektif boyun diseksiyonu yapılması uygundur. Bunlara ek olarak tümör evresi arttıkça sağkalım oranlarının da belirgin bir şekilde düştüğü gözlemlenmiştir.

The relationship between the frequency of cervical metastases and tumor related factors in laryngeal cancer and outcome of surgical treatment in these cases

Objectives: We aimed to assess the associations between localization, size, stage and histopathological differentiation of primary tumor in larynx and neck metastases and the im- pact of disease stage on survival. Materials and methods: We analyzed the medical records of 333 laryngeal cancer patients who underwent total or par- tial laryngectomy as primary treatment, combined with neck dissection and/or postoperative radiotheraphy if required, between 2000 and 2010 years at our clinic. Age and gender of patients, tumor localization, size, stage and histopatholog- ical differentiation of tumor; presence of preoperative posi- tive lymph nodes, performed operations, operation findings and histopathological results were analysed retrospectively. Results: Tumor localizations were glottic in 172 (51.6%) cases, supraglottic in 108 (32.4%), and transglottic 53 (15.9%) of the the cases. In glottic cancers; cervical me- tastases were observed in 18.6% of the patients, whereas occult metastases in 11%. In supraglottic cancers; cervical metastasis rate was 45.3% and occult metastases rate was 24%. In transglottic cancers, cervical metastases rate was 49% and occult metastases was 22.6%. Postoperative re- currence was 41 (12.3%). Postoperative radiotherapy was recommended to 111 of 333 patients. The overall survival rate was 75.4% at 50th month and the cumulative survival rate was 68.9%. Conclusion: In conclusion, although there is controversy regarding the optimal treatment in the N0 larynx cancers, in case of a high risk for occult metastases, elective unilateral or bilateral neck dissection should be performed according to the anatomic localization of the tumor. In addition, survival rate decreased significantly with the increasing tumor stage.

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