Conclusion: Despite the low incidence of superior mediastinal metastasis (SMM) we recommend elective superior mediastinal dissection (ESMD) and close follow-up for all patients with laryngeal carcinoma involving the subglottis, because higher peristomal recurrence (PR) rates and lower survival rates were observed in the presence of SMM numerically even though statistical support was lacking.
Background: This study was undertaken to identify the incidence of SMM and to evaluate the need for ESMD in laryngeal tumors involving the subglottis.
Methods: Medical records of patients who had undergone total laryngectomy for laryngeal carcinoma were reviewed retrospectively and 68 patients (45 with ESMD and 23 without ESMD) who had pathologically proven subglottic involvement were included in the study.
Results: SMM was found in 3 of 45 (6.6%) patients who underwent ESMD. The PR rate was higher in patients with SMM (66.7%) than in patients without SMM (9.5%) and the presence of SMM was significantly related to PR (p = 0.043) in univariate analysis. However, this relationship was not preserved in multivariate analysis. The 3- and 5-year survival rates of patients with SMM were lower (both 66.7%) than patients without SMM (83.3% and 76.2%, respectively), but decreased survival rates did not differ statistically from the survival rates of 42 patients without SMM.
Keywords: Metastasis; laryngectomy; peristomal recurrence; subglottic involvement; superior mediastinal metastasis.