Elective Neck Dissection during Salvage Total Laryngectomy: Personal Experience.

Jacopo Galli,Claudio Parrilla,Stefano Settimi,Antonio Salvati,Giovanni Di Cintio,Gaetano Paludetti,Giovanni Almadori

doi:10.3390/jcm11051438

Abstract

The role of elective neck dissection during salvage surgery in patients with a clinically negative neck (cN0) is still discussed. The main objective of this work was to estimate the prevalence and predictive factors of occult neck nodes metastasis; we therefore aimed to evaluate the survival rate and the main oncologic outcomes of cN0 patients who underwent salvage total laryngectomy and elective bilateral neck dissection. In this retrospective observational study, we enrolled 80 cN0 patients affected by recurrent laryngeal cancer and who underwent salvage total laryngectomy and bilateral selective elective neck dissection. Several parameters were collected in order to find prognostic factors; finally, postoperative complications were reviewed and survival analysis was performed. Occult lymph node metastases were reported in 18 out of 80 patients (22.5%). Significant statistical correlation between lymphovascular invasion (p = 0.007), perineural invasion (p = 0.025) and occult nodal metastasis was found. Other variables (glottic subsite of recurrence, clinical T, pathological T, previous chemotherapy) were not significantly predictive of occult nodal metastasis. The 5-year OS, DSS, and RFS were 50.4%, 64.7%, and 63.4%, respectively. In conclusion, our single-institution data on a large cohort of patients, suggest performing routinely elective selective bilateral neck dissection during salvage total laryngectomy in cN0 patients due to the biological attitude of the tumor to spread to cervical nodes, considering an acceptable complications rate.

Highlights

Surgical and non-surgical organ preservation protocols markedly increased in the 3 last decades, even for locally advanced stages, inducing a relevant decrease of total laryngectomy as a primary treatment that on the contrary still represents the gold standard procedure after the failure of conservative approaches in case of locally recurrent or persistent laryngeal cancer
The aim of this study was at least to evaluate the role of neck dissection in cN0 patients who underwent salvage total laryngectomy, estimating the prevalence of pN+ and predictive factors for cervical lymph nodes metastasis
Secondary goals were the assessment of complication rate and the estimated five-year overall survival (OS), five-year relapse-free survival (RFS), and five-year disease-specific survival (DSS) in these patients

Summary

Introduction

Surgical and non-surgical organ preservation protocols markedly increased in the 3 last decades, even for locally advanced stages, inducing a relevant decrease of total laryngectomy as a primary treatment that on the contrary still represents the gold standard procedure after the failure of conservative approaches in case of locally recurrent or persistent laryngeal cancer. In this setting, the role of elective neck dissection (END). Secondary goals were the assessment of complication rate and the estimated five-year overall survival (OS), five-year relapse-free survival (RFS), and five-year disease-specific survival (DSS) in these patients

Objectives

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Discussion

Conclusion