Optimization of diagnostics and surgical treatment of metastatic cancer of the larynx and hypopharynx

The study objective is to develop new approaches to improve the surgical treatment of laryngeal and hypopharyngeal cancer and the detection of cervical lymph node metastasis in the preoperative period by utilizing own clinical experience.

Materials and methods. We conducted a retrospective analysis of 81 patients treated in Department of Otolaryngology in Scientific and Clinical Center of Otorhinolaryngology, Federal Medico-Biological Agency of the Russia. The 39 patients in the experimental group underwent total laryngectomy with neck dissection in our modification. With this proprietary technology modified vertical incision begins from occipital region, continues along the posterior border of the sternocleidomastoid muscle, crosses over this muscle and ends at sternoclavicular joint. The medial part of the sternocleidomastoid muscle was attached to the prevertebral fascia, thus swabbing the carotid neurovascular bundle. The patients in the control group underwent total laryngectomy and conventional neck dissection (42 patients). For morphological verification of cervical lymphadenopathies preoperative diagnostic included a fine-needle biopsy of suspected lymph nodes followed with cytology. The patients with negative cytology underwent harpoon percutaneous biopsy followed with cytological and histopathological examination of the lymph nodes.

Results. Harpoon percutaneous biopsy increased accuracy of preoperative diagnosis from 59.3 to 96.3 % in our study, allowing the most favorable therapy; 3.7 % of lymph node metastases were not diagnosed before surgery. Because of this we believe, that preventive neck dissection is necessary.

Conclusion. Harpoon percutaneous biopsy increased accuracy of histopathological diagnosis by 37 % as compared to fine-needle biopsy. We consider, that anchoring of the medial part of the sternocleidomastoid muscle to the prevertebral fascia allows the reliable separating of larynx and laryngopharynx from the carotid neurovascular bundle.