Surgical Management of the Lymphatic System with Regard to Supraglottic Resections of the Larynx
Neck metastases account for most surgical and radiation failures in patients with supraglottic carcinoma. Therefore, management of the cervical nodes often determines the eventual outcome of the disease. My associates and I (Coates et al. 1976; DeSanto et al. 1977) advocate neck dissection for virtually all patients except those with small epiglottic (Tla) tumors; for these patients, a wait-and-watch policy is followed. The low morbidity and mortality (1.6%) after the operation and the long-term outcome of the patients at the Mayo Clinic justify this approach. Furthermore, neck dissection facilitates the execution of the supraglottic operation and gives the surgeon surgical staging information. The close cooperation and assistance of a surgical pathologist skilled and efficient in fresh-frozen section diagnosis of nodal cancer are required. In our practice, the neck dissection is carried out on one side of the neck in a noncontiguous operation. The nodes are sectioned and studied by the pathologist while the primary tumor is being excised.
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