Management of the N0 neck in moderately advanced squamous carcinoma of the larynx

Abstract

Objective To assess the oncological efficacy of selective neck dissection (SND) in patients with T3-4 N0 laryngeal squamous carcinoma. Subjects and Methods A total of 327 patients underwent 654 neck dissections; each side of the neck was individually evaluated. Results Three percent of patients who had SND developed regional recurrence (RR) in comparison with 11.7 percent of patients who underwent modified radical neck dissection (MRND) ( P = 0.005). Only 3 (0.9%) patients developed RR outside the field of SND. The presence of extracapsular extension ( P = 0.002) in node-positive (pN+) group and of microvascular invasion ( P = 0.007), together with the type of neck dissection (ND) ( P = 0.0003) in node-negative (pN0) group had statistical impact on RR. The development of RR significantly affected disease-specific survival ( P = 0.0001). Equivalent rates of RR were found in pN+ (2.6%) or pN0 (3.2%) patients treated with SND ( P = 0.98) as well as in pN+ patients who underwent SND (2.6%) or MRND (4.7%) ( P = 0.85). Conclusion This study confirmed the adequacy of SND as a satisfactory staging and therapeutic procedure, and suggests its use in the treatment of limited node-positive (N+) neck.