Does unnecessary elective neck treatment affect the prognosis of N0 laryngeal cancer patients?

Among detractors of elective neck (N0) treatments, most suggest that lymphadenectomy removes a barrier to the spread of disease with deleterious immunologic consequences. To test this hypothesis we performed a retrospective comparison of the survival results of N0 laryngeal cancer patients who received unnecessary elective neck treatments (N0-) and those of N0 patients subjected to close and regular follow-up.

A retrospective chart review of 749 N0 laryngeal cancer patients treated at the Institute of Otolaryngology-Head and Neck Surgery, University of Florence between January 1980 and January 1993 was performed. Of these, 245 (33%) received elective neck dissection (ED), while the remaining 504 (67%) N0 patients were subjected to close and regular follow-up (wait-and-see policy; WS).

Of the 245 ED patients, 43 (17.5%) showed an occult neck disease, while of the 504 WS subjects, 83 (17%) developed neck metastases during follow-up. Moreover, 15 ED patients subsequently experienced a contralateral occult failure despite a unilateral negative neck specimen (N0-). Thus, ultimately 187 ED (164 of whom were treated unilaterally and 23 bilaterally) and 421 WS patients were used for survival analysis. No differences in terms of postoperative complications, local or distant failure or disease-free or overall actuarial survival were found between the two groups analyzed.

These data indicate that unilateral or bilateral removal of cervical lymphatics in the absence of histologically proven lymph node metastases does not negatively affect the prognosis of N0 laryngeal cancer patients who were overtreated to the neck.