Outcomes and Oncologic Considerations for Elective Neck Dissection in Patients Undergoing Salvage Laryngectomy

Abstract

Objectives: Most patients treated with organ-preservation schemas for laryngeal cancer have no nodal disease at the time of recurrence. The oncologic benefit of an elective neck dissection (END) in a patient with clinically N0 neck at the time of salvage laryngectomy (SL) is still controversial. We sought to determine the oncologic outcomes for END and identify predictors for pN(+) status. Methods: Retrospective chart review of 180 patients who underwent laryngectomy between 2004 and 2013 was performed. Fifty-eight patients met inclusion criteria and the cohort was divided into 2 groups depending upon the END status. Demographics, pathology, and oncologic outcomes were compared. Results: The study was comprised of 46 (79.3%) males and 12 (20.7%) females with a mean age of 60.5 years (range, 24-88 years; SD = 10 years). Nineteen patients (32.8%) were managed conservatively while 39 (67.2%) had END, uni- or bilateral. Out of a total of 71 ENDs, 5 necks in 4 patients had positive nodal disease. The only statistically significant predictor for pN(+) status was T-stage ( P = .017). Contrary to other reports, tumor location (glottis vs. supraglottic) was not a factor. The 5-year disease-free survival was 53.8%, and it was significantly lower for patients who underwent an END ( P = .032). Conclusions: We found that 7% of the dissected necks had positive disease, and the only predictor for pN(+) status was tumor T-stage. END did not improve locoregional control or survival compared to observation. Our findings suggest END is warranted in patients presenting with locally advanced recurrences, while observation might be preferable in other instances.