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

Larenks kanserli hastalarda servikal metastazların boyundaki seviyelere göre dağılım sıklığı

Amaç: Bu çalışmamızda boyun diseksiyonu yapılan larenks kanserli vakaların boyunda yapmış oldukları servikal metastazlarının boyundaki seviyelere göre dağılım sıklığını incelemeyi amaçladık. Aynı zamanda özellikle preoperatif N0 kabul edilen vakalarda kapsamlı bir boyun diseksiyonu yerine yapılacak olan selektif bir boyun diseksiyonun güvenli bir cerrahi yaklaşım olup olmayacağı araştırıldı. Gereç ve yöntem: Kliniğimizde boyundaki seviyelere göre metastaz sıklığının tespitinde kolaylık sağlaması açısından boyun diseksiyonu sonrası spesmen bölünerek her seviye ayrı ayrı patolojik incelemeye gönderilmektedir. Bizim çalışmamızda 2005 ve 2010 yılları arasında Kulak Burun Boğaz Kliniğinde larenks kanseri nedeniyle primer tedavi olarak cerrahi (total veya parsiyel larenjektomi) uygulanmış olan ve boyun diseksiyonu yapılan 145 hastanın dosyaları incelendi. Larenks kanseri tanısı almış olup cerrahi tedavide boyun diseksiyonu yapılmayan hastalar çalışmaya alınmadı. Bulgular: Preoperatif N0 vakalarda level I veya Level V tutulumu hiç gözlenmedi. Kontralateral tutulumu olan vakaların hepsinde ipsilateral tutulum da mevcuttu ve bu vakaların hepsi klinik olarak preoperatif N+ vakalardı. 145 vakanın yapmış olduğu servikal metastazların seviyelere göre dağılımı incelendiğinde ise ipsilateral tutulumların 1inde (%0.6) level IA, 32sinde (%22) level IIA, 3ünde (%2) level IIB, 19unda (%13) level III, 2sinde (%1.3) level IV, 1inde (%0.6) level V olduğu gözlenmiştir. Kontralateral tutulumların ise 13ünde (%8.9) level IIA, 1inde (%0.6) level III tutulumu olmuştur. Sonuç: Kliniğimizde larenjektomiyle beraber boyun diseksiyonu yapılan 145 larenks karsinomlu hastanın boyun spesmen incelemelerinde en sık metastazın level IIA ve level III e olduğu gözlendi. En az metastazın ise level I, level IIB, level IV ve level Vte olduğu gözlendi. Bu sonuçlar ışığında özellikle T1 T2 N0 vakalarda selektif boyun diseksiyonunun (level 2-4) güvenli bir cerrahi yaklaşım olacağı sonucuna varılmıştır.

The frequency of distribution of cervical metastases according to the neck level in patients with larynx cancer

Objectives: In this study we aimed to assess the frequency of distribution for cervical metastases, according to the neck level in patients with larynx cancer who underwent neck dissection. In addition, we also evaluated the safety of selective neck dissection compared to comprehensive neck dissection especially in preoperative N0 patients. Materials and methods: In our experience, to determine the frequency of metastases in each level, the specimen is sent for pathological examination by dividing each level separately after neck dissection. In our study; we retrospectively analysed the medical records of 145 laryngeal cancer patients who were treated with surgery (total or partial laryngectomy) as primary treatment and combined with neck dissection between 2005 and 2010 in our Otolaryngology Department. The patients with the diagnosis of laryngeal cancer who underwent surgery without neck dissection were excluded from the analysis. Results: Level I or level V involvement was not observed in preoperative N0 cases. In cases that had contralateral involvement, there was ipsilateral involvement too and all of these cases were preoperative N+ cases. The classification based on the distribution of levels of 145 cases cervical metastases revealed that among ipsilateral involvements, 1 (0.6%) was detected at level IA, 32 (22%) at level IIA, 3 (2%) at level IIB, 19 (13%) at level III, 2 (1.3%) at level IV and 1 (1.3%) at level V. When contralateral involvement considered, 13 (8.9%) were detected at level IIA and 1 (0.6%) at level III. Conclusions: The neck specimen findings of 145 laryngeal cancer patients treated with surgery as either total or partial laryngectomy and combined with neck dissection revealed that the most common metastases were observed at the level IIA and level III; however metastases at level I, level IIB, level IV and level V were least common. Those findings indicated that selective neck dissection was a safe surgical approach (levels II-IV) in T1 T2 N0 cases.

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