Incidence of Occult Nodal Disease in Patients Treated with Salvage Laryngectomy with Radiologically Negative Neck

Abstract

Objectives: The National Comprehensive Cancer Network guidelines address neck dissection in the setting of primary tumor treatment but do not provide a clear guideline for negative nodal disease in recurrent advanced laryngeal cancer. We often extrapolate the indication of neck dissection for recurrent disease based on the guidelines of primary disease. It is controversial whether there is a survival benefit for patients with clinically and radiologically negative (N0) necks to receive a neck dissection versus conservative management. This study aims to determine survival outcomes and incidence of post-operative complications in patients who underwent neck dissection at the time of salvage laryngectomy with clinically and radiologically negative neck. Methods: Single institution case series at a tertiary care university hospital. We identified 424 cases of total laryngectomy between 2000-2010.We reviewed the subset of N0 patients who had salvage laryngectomy and divided them into neck dissection versus conservative management. We reviewed demographic variables, final pathological stage of dissected neck specimen, and post-operative course and survival. Results: Patients who had a neck dissection at salvage laryngectomy with clinically N0 disease as compared to those treated conservatively may have no significant difference in survival; there may be a significant difference in the complication rate and perioperative mortality rate between the two groups. Conclusions: The data reviewed in this large series of patients will be useful for clinicians to determine the survival and complications that are frequently experienced by patients following neck dissection with salvage laryngectomy in the setting of previous radiation.