Paratracheal lymph node involvement in advanced cancer of the larynx, hypopharynx, and cervical esophagus

Objectives/Hypothesis: The presence of nodal metastatic disease in head and neck cancer is the foremost prognostic factor. Although neck dissection is the surgical gold standard for the treatment of cervical lymphatic spread, the paratracheal nodal group is not routinely included in the dissection. The study determined the nodal yield, presence of metastases, and prognostic importance of paratracheal nodes in patients with advanced carcinoma of the upper aerodigestive tract. Study Design: Prospective histological and survival analysis. Methods: Over a 4-year period (October 1994-June 1998), consecutive patients undergoing laryngectomy with or without pharyngectomy or cervical esophagectomy underwent paratracheal node dissection on a prospective basis. Nodal tissue was examined for the presence of metastases. Statistical comparison of survival probability was determined by use of log-rank/chi(2) test. Results: Fifty patients have been included in the study to date, with a minimal follow-up of 3 years. The average number of paratracheal nodes dissected was three per side (range, 1-5). Thirteen (26%) patients demonstrated histological evidence of paratracheal. nodal metastases (larynx, 20%; postericoid/cervical esophageal region, 43%). Five patients (10%) had positive paratracheal nodes alone in a histologically negative cervical neck dissection. The majority of positive paratracheal nodes were less than 1 cm in diameter and appeared negative preoperatively. The absence of positive paratracheal nodes may have a survival benefit. Conclusion: The study highlighted the propensity of advanced carcinoma of the upper aerodigestive tract to involve the paratracheal nodes. This area should be routinely dissected in the surgical management of these tumors.