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Should elective neck dissection be routinely performed in patients undergoing salvage total laryngectomy?

Published online by Cambridge University Press:  17 March 2014

T F Pezier ,
I J Nixon ,
W Scotton ,
A Joshi ,
T Guerrero-Urbano ,
R Oakley ,
J-P Jeannon  and
R Simo
T F Pezier*
Affiliation:
Department of Otorhinolaryngology Head and Neck Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, UK
I J Nixon
Affiliation:
Department of Otorhinolaryngology Head and Neck Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, UK
W Scotton
Affiliation:
Department of Otorhinolaryngology Head and Neck Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, UK
A Joshi
Affiliation:
Department of Otorhinolaryngology Head and Neck Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, UK
T Guerrero-Urbano
Affiliation:
Department of Otorhinolaryngology Head and Neck Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, UK
R Oakley
Affiliation:
Department of Otorhinolaryngology Head and Neck Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, UK
J-P Jeannon
Affiliation:
Department of Otorhinolaryngology Head and Neck Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, UK
R Simo
Affiliation:
Department of Otorhinolaryngology Head and Neck Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, UK
*
Address for correspondence: Mr T Pezier, ORL-Klinik, University Hospital Zurich, 8008 Zurich, Switzerland E-mail: tfrpezier@gmail.com
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Abstract

Background:

The prevalence of occult neck metastasis in patients undergoing salvage total laryngectomy remains unclear, and there is controversy regarding whether elective neck dissection should routinely be performed.

Method:

A retrospective case note review of 32 consecutive patients undergoing salvage total laryngectomy in a tertiary centre was performed, in order to correlate pre-operative radiological staging with histopathological staging.

Results:

The median patient age was 61 years (range, 43–84 years). With regard to lymph node metastasis, 28 patients were pre-operatively clinically staged (following primary radiotherapy or chemoradiotherapy) as node-negative, 1 patient was staged as N1, two patients as N2c and one patient as N3. Fifty-two elective and seven therapeutic neck dissections were performed. Pathological analysis up-staged two patients from clinically node-negative (following primary radiotherapy or chemoradiotherapy) to pathologically node-positive (post-surgery). No clinically node-positive patients were down-staged. More than half of the patients suffered a post-operative fistula.

Conclusion:

Pre-operative neck staging had a negative predictive value of 96 per cent. Given the increased complications associated with neck dissection in the salvage setting, consideration should be given to conservative management of the neck in clinically node-negative patients (staged following primary radiotherapy or chemoradiotherapy).

Keywords

LaryngectomyHead And Neck CancerSquamous Cell CarcinomaSalvage TherapyNeck Dissection
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 128 , Issue 3 , March 2014 , pp. 279 - 283
Copyright
Copyright © JLO (1984) Limited 2014 

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Footnotes

Presented orally at the European Congress on Head and Neck Oncology Meeting, 18–21 April 2012, Poznan, Poland and at the British Association of Head and Neck Oncologists Meeting, 26–27 April 2012, London, UK, and presented as a poster at the American Head and Neck Societies Meeting, 21–25 July 2012, Toronto, Canada.

References

1Forastiere, AA, Goepfert, H, Maor, M, Pajak, TF, Weber, R, Morrison, W et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 2003;349:2091–8CrossRefGoogle ScholarPubMed
2Bohannon, IA, Desmond, RA, Clemons, L, Magnuson, JS, Carroll, WR, Rosenthal, EL. Management of the N0 neck in recurrent laryngeal squamous cell carcinoma. Laryngoscope 2010;120:58–61Google Scholar
3Weber, RS, Berkey, BA, Forastiere, A, Cooper, J, Maor, M, Goepfert, H et al. Outcome of salvage total laryngectomy following organ preservation therapy: the Radiation Therapy Oncology Group trial 91-11. Arch Otolaryngol Head Neck Surg 2003;129:44–9Google Scholar
4Farrag, TY, Lin, FR, Cummings, CW, Koch, WM, Flint, PW, Califano, JA et al. Neck management in patients undergoing postradiotherapy salvage laryngeal surgery for recurrent/persistent laryngeal cancer. Laryngoscope 2006;116:1864–6CrossRefGoogle ScholarPubMed
5Wax, MK, Touma, BJ. Management of the N0 neck during salvage laryngectomy. Laryngoscope 1999;109:4–7CrossRefGoogle ScholarPubMed
6Scotton, W, Cobb, R, Pang, L, Nixon, I, Joshi, A, Jeannon, JP et al. Post-operative wound infection in salvage laryngectomy: does antibiotic prophylaxis have an impact? Eur Arch Otorhinolaryngol 2012;269:2415–22CrossRefGoogle ScholarPubMed
7Hoffman, HT, Porter, K, Karnell, LH, Cooper, JS, Weber, RS, Langer, CJ et al. Laryngeal cancer in the United States: changes in demographics, patterns of care, and survival. Laryngoscope 2006;116:1–13CrossRefGoogle ScholarPubMed
8Olsen, KD. Reexamining the treatment of advanced laryngeal cancer. Head Neck 2010;32:1–7CrossRefGoogle ScholarPubMed
9Wolf, GT. Reexamining the treatment of advanced laryngeal cancer: the VA laryngeal cancer study revisited. Head Neck 2010;32:7–14CrossRefGoogle Scholar
10Forastiere, AA. Larynx preservation and survival trends: should there be concern? Head Neck 2010;32:14–17Google Scholar
11Ganly, I, Patel, SG, Matsuo, J, Singh, B, Kraus, DH, Boyle, J et al. Predictors of outcome for advanced-stage supraglottic laryngeal cancer. Head Neck 2009;31:1489–95Google Scholar
12Tabet, JC, Johnson, JT. Wound infection in head and neck surgery: prophylaxis, etiology and management. J Otolaryngol 1990;19:197–200Google ScholarPubMed
13Penel, N, Lefebvre, D, Fournier, C, Sarini, J, Kara, A, Lefebvre, JL. Risk factors for wound infection in head and neck cancer surgery: a prospective study. Head Neck 2001;23:447–55Google Scholar
14Velanovich, V. A meta-analysis of prophylactic antibiotics in head and neck surgery. Plast Reconstr Surg 1991;87:429–34Google Scholar
15Sassler, AM, Esclamado, RM, Wolf, GT. Surgery after organ preservation therapy. Analysis of wound complications. Arch Otolaryngol Head Neck Surg 1995;121:162–5CrossRefGoogle ScholarPubMed
16Wakisaka, N, Murono, S, Kondo, S, Furukawa, M, Yoshizaki, T. Post-operative pharyngocutaneous fistula after laryngectomy. Auris Nasus Larynx 2008;35:203–8CrossRefGoogle ScholarPubMed
17Ogihara, H, Takeuchi, K, Majima, Y. Risk factors of postoperative infection in head and neck surgery. Auris Nasus Larynx 2009;36:457–60Google Scholar
18Penel, N, Fournier, C, Lefebvre, D, Lefebvre, JL. Multivariate analysis of risk factors for wound infection in head and neck squamous cell carcinoma surgery with opening of mucosa. Study of 260 surgical procedures. Oral Oncol 2005;41:294–303CrossRefGoogle ScholarPubMed
19Morgan, JE, Breau, RL, Suen, JY, Hanna, EY. Surgical wound complications after intensive chemoradiotherapy for advanced squamous cell carcinoma of the head and neck. Arch Otolaryngol Head Neck Surg 2007;133:10–14Google Scholar
20Bieri, S, Bentzen, SM, Huguenin, P, Allal, AS, Cozzi, L, Landmann, C et al. Early morbidity after radiotherapy with or without chemotherapy in advanced head and neck cancer. Experience from four nonrandomized studies. Strahlenther Onkol 2003;179:390–5CrossRefGoogle ScholarPubMed
21Lavertu, P, Bonafede, JP, Adelstein, DJ, Saxton, JP, Strome, M, Wanamaker, JR et al. Comparison of surgical complications after organ-preservation therapy in patients with stage III or IV squamous cell head and neck cancer. Arch Otolaryngol Head Neck Surg 1998;124:401–6CrossRefGoogle ScholarPubMed
22Yao, M, Roebuck, JC, Holsinger, FC, Myers, JN. Elective neck dissection during salvage laryngectomy. Am J Otolaryngol 2005;26:388–92CrossRefGoogle ScholarPubMed
23Gilbert, MR, Branstetter, BF 4th, Kim, S. Utility of positron-emission tomography/computed tomography imaging in the management of the neck in recurrent laryngeal cancer. Laryngoscope 2012;122:821–5Google Scholar
24Mendenhall, WM, Parsons, JT, Brant, TA, Stringer, SP, Cassisi, NJ, Million, RR. Is elective neck treatment indicated for T2N0 squamous cell carcinoma of the glottic larynx? Radiother Oncol 1989;14:199–202CrossRefGoogle ScholarPubMed
25Matsuo, JM, Patel, SG, Singh, B, Wong, RJ, Boyle, JO, Kraus, DH et al. Clinical nodal stage is an independently significant predictor of distant failure in patients with squamous cell carcinoma of the larynx. Ann Surg 2003;238:412–21CrossRefGoogle ScholarPubMed
26Tankere, F, Camproux, A, Barry, B, Guedon, C, Depondt, J, Gehanno, P. Prognostic value of lymph node involvement in oral cancers: a study of 137 cases. Laryngoscope 2000;110:2061–5Google Scholar
27van den Brekel, MW, van der Waal, I, Meijer, CJ, Freeman, JL, Castelijns, JA, Snow, GB. The incidence of micrometastases in neck dissection specimens obtained from elective neck dissections. Laryngoscope 1996;106:987–91CrossRefGoogle ScholarPubMed
28Alex, JC, Krag, DN. The gamma-probe-guided resection of radiolabeled primary lymph nodes. Surg Oncol Clin N Am 1996;5:33–41CrossRefGoogle ScholarPubMed
29Pitman, KT, Johnson, JT, Myers, EN. Effectiveness of selective neck dissection for management of the clinically negative neck. Arch Otolaryngol Head Neck Surg 1997;123:917–22CrossRefGoogle ScholarPubMed
30Shah, JP. Patterns of cervical lymph node metastasis from squamous carcinomas of the upper aerodigestive tract. Am J Surg 1990;160:405–9Google Scholar
31Perie, S, Hugentobler, A, Susini, B, Balogova, S, Grahek, D, Kerrou, K et al. Impact of FDG-PET to detect recurrence of head and neck squamous cell carcinoma. Otolaryngol Head Neck Surg 2007;137:647–53CrossRefGoogle ScholarPubMed
32Brouwer, J, Hooft, L, Hoekstra, OS, Riphagen, II, Castelijns, JA, de Bree, R et al. Systematic review: accuracy of imaging tests in the diagnosis of recurrent laryngeal carcinoma after radiotherapy. Head Neck 2008;30:889–97CrossRefGoogle ScholarPubMed
33Pezier, T, Nixon, IJ, Gurney, B, Schilling, C, Hussain, K, Lyons, AJ et al. Sentinel lymph node biopsy for T1/T2 oral cavity squamous cell carcinoma–a prospective case series. Ann Surg Oncol 2012;19:3528–33Google Scholar
34de Hullu, JA, Piers, DA, Hollema, H, Aalders, JG, van der Zee, AG. Sentinel lymph node detection in locally recurrent carcinoma of the vulva. BJOG 2001;108:766–8Google ScholarPubMed
35Flach, GB, Broglie, MA, van Schie, A, Bloemena, E, Leemans, CR, de Bree, R et al. Sentinel node biopsy for oral and oropharyngeal squamous cell carcinoma in the previously treated neck. Oral Oncol 2012;48:85–9Google Scholar
36Thoeny, HC. Diffusion-weighted MRI in head and neck radiology: applications in oncology. Cancer Imaging 2011;10:209–14Google Scholar
37Tshering Vogel, DW, Zbaeren, P, Geretschlaeger, A, Vermathen, P, De Keyzer, F, Thoeny, HC. Diffusion-weighted MR imaging including bi-exponential fitting for the detection of recurrent or residual tumour after (chemo)radiotherapy for laryngeal and hypopharyngeal cancers. Eur Radiol 2012;23:562–9CrossRefGoogle ScholarPubMed
38van den Brekel, MW, Stel, HV, van der Valk, P, van der Waal, I, Meyer, CJ, Snow, GB. Micrometastases from squamous cell carcinoma in neck dissection specimens. Eur Arch Otorhinolaryngol 1992;249:349–53Google Scholar
39Temam, S, Koka, V, Mamelle, G, Julieron, M, Carmantrant, R, Marandas, P et al. Treatment of the N0 neck during salvage surgery after radiotherapy of head and neck squamous cell carcinoma. Head Neck 2005;27:653–8CrossRefGoogle ScholarPubMed