Skip to main content Accessibility help
×
Home

Elective neck dissection for the node-negative neck during salvage laryngectomy: an analysis of survival outcomes and complication rates

  • M Gouzos (a1), O Dale (a1), N Sethi (a1), A Foreman (a1), S Krishnan (a1) and JC Hodge (a1)...

Abstract

Objectives

This study aimed to evaluate the effect of neck dissection on survival and complication rates in patients with no clinical or radiological evidence of cervical nodal disease (N0) undergoing salvage laryngectomy.

Methods

A retrospective study was conducted of patients with squamous cell carcinoma of the larynx following primary radiotherapy that required salvage laryngectomy. Disease-free and overall survival rates were compared over three years using Kaplan–Meier analysis. Pharyngocutaneous fistula rate, hospitalisation length and the requirement for further surgical intervention were also compared across cohorts.

Results

Twenty-three cases met the inclusion criteria (17 neck dissections, 6 undissected). No significant differences in survival outcomes were identified. One patient who underwent neck dissection for advanced, recurrent transglottic squamous cell carcinoma showed evidence of occult lymph node metastases. Fistula rates did not differ significantly between dissected and non-dissected groups; however, two patients required surgical repair of post-operative pharyngocutaneous fistula following neck dissection.

Conclusion

In this study, elective neck dissection did not appear to alter survival outcomes or complication rates during salvage laryngectomy. Given the small but significant risk of occult neck metastases, its true value remains unclear.

Copyright

Corresponding author

Author for correspondence: Dr J C Hodge, Department of Otolaryngology – Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, SA 5000, Australia E-mail: jchodge27@hotmail.com

Footnotes

Hide All

Dr J C Hodge takes responsibility for the integrity of the content of the paper

Footnotes

References

Hide All
1Brenner, B, Marshak, G, Sulkes, A, Rakowsky, E. Prognosis of patients with recurrent laryngeal carcinoma. Head Neck 2000;23:531–5
2Basheeth, N, O'Leary, G, Sheahan, P. Elective neck dissection for N0 neck during salvage total laryngectomy: findings, complications, and oncological outcome. JAMA Otolaryngol Head Neck Surg 2013;139:790–610.1001/jamaoto.2013.3995
3Bohannon, I, Desmond, R, Clemons, L, Magnuson, J, Carroll, W, Rosenthal, E. Management of the N0 neck in recurrent laryngeal squamous cell carcinoma. Laryngoscope 2010;120:5861
4Dagan, R, Morris, C, Kirwan, J, Werning, J, Vaysberg, M, Amdur, R et al. Elective neck dissection during salvage surgery for locally recurrent head and neck squamous cell carcinoma after radiotherapy with elective nodal irradiation. Laryngoscope 2010;120:945–52
5Yirmibesoglu, E, Fried, D, Shores, C, Rosenman, J, Weissler, M, Hackman, T et al. Incidence of subclinical nodal disease at the time of salvage surgery for locally recurrent head and neck cancer initially treated with definitive radiation therapy. Am J Clin Oncol 2013;36:475–80
6Sayles, M, Grant, D. Preventing pharyngo-cutaneous fistula in total laryngectomy: a systematic review and meta-analysis. Laryngoscope 2014;124:1150–63
7Deganello, A, Meccariello, G, Bini, B, Paiar, F, Santoro, R, Mannelli, G et al. Is elective neck dissection necessary in cases of laryngeal recurrence after previous radiotherapy for early glottic cancer? J Laryngol Otol 2014;128:1089–9410.1017/S0022215114002709
8Farrag, T, Lin, F, Cummings, C, Koch, W, Flint, P, Califano, J et al. Neck management in patients undergoing postradiotherapy salvage laryngeal surgery for recurrent/persistent laryngeal cancer. Laryngoscope 2006;116:1864–6
9Koss, S, Russell, M, Leem, T, Schiff, B, Smith, R. Occult nodal disease in patients with failed laryngeal preservation undergoing surgical salvage. Laryngoscope 2014;124:421–8
10Birkeland, A, Rosko, A, Issa, M, Shuman, A, Prince, M, Wolf, G et al. Occult nodal disease prevalence and distribution in recurrent laryngeal cancer requiring salvage laryngectomy. JAMA Otolaryngol Head Neck Surg 2016;154:473–9
11Freiser, M, Ojo, R, Lo, K, Saint-Victor, S, Bollig, C, Nayak, C et al. Complications and oncologic outcomes following elective neck dissection with salvage laryngectomy for the N0 neck. Am J Otolaryngol 2016;37:186–94
12Sanabria, A, Silver, C, Olsen, K, Medina, J, Hamoir, M, Paleri, V et al. Is elective neck dissection indicated during salvage surgery for head and neck squamous cell carcinoma? Eur Arch Otorhinolaryngol 2014;271:3111–19
13Wax, M, Touma, B. Management of the N0 neck during salvage laryngectomy. Laryngoscope 1999;109:4710.1097/00005537-199901000-00002
14Yao, M, Roebuck, J, Holsinger, F, Myers, J. Elective neck dissection during salvage laryngectomy. Am J Otolaryngol 2005;26:388–92
15Amit, M, Hilly, O, Leider-Trejo, L, Popovtze, A, Gutfeld, O, Shvero, J et al. The role of elective neck dissection in patients undergoing salvage laryngectomy. Head Neck 2013;35:1392–6
16Hilly, O, Stern, S, Horowitz, E, Leshno, M, Feinmesser, R. Is there a role for elective neck dissection with salvage laryngectomy? A decision-analysis model. Laryngoscope 2013;123:2706–11
17Pezier, T, Nixon, I, Scotton, W, Joshi, A, Guerrero-Urbano, T, Oakley, R et al. Should elective neck dissection be routinely performed in patients undergoing salvage total laryngectomy? J Laryngol Otol 2014;128:279–83
18Pellini, R, Mercante, G, Marchese, C, Terenzi, V, Spoerduti, I, Manciocco, V et al. Predictive factors for postoperative wound complications after neck dissection. Acta Otorhinolaryngol Ital 2013;33:1622
19Paleri, V, Drinnan, M, van den Brekel, M, Hinni, M, Bradley, P, Wolf, G et al. Vascularized tissue to reduce fistula following salvage total laryngectomy: a systematic review. Laryngoscope 2014;124:1848–5310.1002/lary.24619

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed