Metastase linfatica de carcinoma espinocelular no apice do triangulo posterior : avaliação de fatores de risco clinicos e histopatologicos

AUTOR(ES)
DATA DE PUBLICAÇÃO

2000

RESUMO

Dissection of posterior triangle apex (APEX) is a surgical step in supraomohyoid and lateral neck dissections. The prevalence of lymphatic metastases at this site and the clinico-histopathological conditions that influence their occurrence have not been established. We have evaluated the prevalence and the risk factors for cervical metastases in lymph nodes of the APEX. Sixty-two neck dissections were performed in 51 patients with squamous cell carcinoma of the oropharynx, hypopharynx, oral cavity, glottic larynx and supraglottic larynx or with occult primary cancers. We correlated the presence of positive metastases in the APEX with the neck level involved either clinically(CLIN) or histopathologically (H/P) and with the number of CLIN or H/P positive neck levels with metastases. The prevalence of metastases in the APEX in elective(NO) and therapeutic(N+) neck dissections was also compared. This prevalence was also compared with that for each neck level. The histopathological comparison between the APEX and the neck levels were calculated for NO, N+ and all neck dissections. The primary site of tumor was correlated with the presence of HIP positive nodes in the APEX. The overall prevalence of lymphatic metastases in the APEX was 6.5%. The prevalence in NO neck dissections was 2.3% and in N+ neck dissections, 16.7%. The prevalence of lymphatic metastases in the APEX for primary of pharynx was 23.1 %, for oral cavity was 3.6% and 0% for other sites. Metastases in the APEX were not influenced by the neck level with CLIN or H/P metastases in N+ necks. The number of CLIN or H/P positive neck levels had no influence on histopathological metastases in the APEX. Factors that influenced metastases in the APEX were positive histopathological metastases at level TI for NO neck dissections and positive histopathological metastases at level II or III for all neck dissections. All the comparisons were analyzed using the Fisher s or Poisson s test . The prevalence of histopathological metastases in the APEX in N+ necks is 7.3 times greater than that of NO necks and for primary tumor of pharynx was 6.4 times than for oral cavity. The prevalence of histopathological metastases in the APEX for primary tumor of pharynx was statistically signicantly greater than for prymary tumor of Iarynx (p = 0.0478).Histopathological metastases at level II for clinically NO necks and histopathological metastases to level II or m for all neck dissections are risk factors for metastases in the APEX. The number of positive levels did not influence the prevalence of metastases in the APEX. There is no isolated metastases in the APEX of posterior triangle

ASSUNTO(S)

pescoço dissecação humana metastase cancer

ACESSO AO ARTIGO

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