Significance of Retropharyngeal Node Dissection at Radical Surgery for Carcinoma of the Hypopharynx and Cervical Esophagus

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Abstract
To clarify the efficacy of dissection of retropharyngeal lymph nodes (RPLNs) in the surgical treatment of carcinoma of the hypopharynx and cervical esophagus. We started planned dissection of the RPLN during initial radical surgery in patients with squamous cell carcinoma of the hypopharynx or the cervical esophagus in 1988. Until 1997, we performed this procedure as a standard operation in 82 consecutive patients. Mortality resulting from RPLN metastasis was compared between 82 patients who underwent RPLN dissection and 69 patients who did not undergo the procedure. Of 82 patients, 16 patients (20%) had positive RPLNs. These patients were at high risk of recurrence unless the node(s) were dissected. Although RPLN dissection did not improve the cumulative 5-year survival rate, it significantly decreased the number of patients who died of RPLN metastasis (chi2 = 3.68, P <.1). Four of the 16 patients who had positive RPLNs survived without any recurrence. Bilateral dissection of the RPLN during initial surgery is highly recommended in every surgical case of carcinoma of the hypopharynx and cervical esophagus.