喉頭癌声門下進展例の臨床・病理組織学的研究 : どこからが声門下進展か

A clinico-pathological study of the extension to the subglottic area of the larynx was performed in T3 or T4 laryngeal cancer patients who received total laryngectomies at Kurume University Hospital between 1991 and 1997. There were 63 (21 glottic and 42 supraglottic) patients during this period and the following results are obtained : 1) The frequency of metastasis to the paratracheal or prelaryngeal lymph nodes was 29% in glottic cancers, and 10% in supraglottic cancers.2) The frequency of metastasis to the paratracheal or prelaryngeal lymph nodes increased to 56% (glottic cancers) and 40% (supraglottic cancers) for those patients whose tumor extended to the subglottic area of the larynx.3) In cases that were free from subglottic extension but CA invasion was detected, paratracheal or prelaryngeal lymph node metastasis was found in 50% of glottic and 33% of supraglottic cancer patients.4) There was no metastasis to the paratracheal or prelaryngeal lymph nodes when the examined glottic and supraglottic cancers were free from invasion to both the subglottic and CA.5) From these findings, we submit that the distance of the subglottic extension of laryngeal cancer is more than 10mm at the anterior commissure and was less than 10mm at the membranous vocal cord and the posterior commissure.6) Dissection of the paratracheal lymph nodes as well as postoperative radiation is thought to be highly beneficial for preventing stomal recurrence.