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Elective neck treatment during salvage (pharyngo) laryngectomy

Simone E Bernard¹, Marjan H Wieringa², Cees A Meeuwis²

¹Department of Otorhinolaryngology and Head and Neck surgery, ErasmusMC Cancer Institute, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. s.bernard@erasmusmc.nl.

European Archives of Oto-Rhino-Laryngology : Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : Affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery

|January 6, 2019

Abstract

Purpose:

This study aimed at determining the importance of an elective neck dissection (END) in case of a cN0 laryngeal or hypopharyngeal carcinoma after (chemo) radiation.

Methods:

Retrospective review was made of patients treated in a single tertiary center between 2002 and 2014. Influence of an END in case of a cN0 salvage laryngectomy on complications, recurrence-free survival and disease-specific survival was assessed.

Inclusion Criteria:

squamous cell carcinoma and cN0 neck.

Exclusion Criteria:

second primary tumor in the head and neck, a total laryngectomy because of a dysfunctional larynx, or a previously performed neck dissection.

Results:

Of the 86 included patients, 27 (31%) underwent an END, of which 1 had occult metastasis (4%). Of the remaining 59 patients (69%) without an END, 3 developed a regional recurrence (5%). The overall survival was significantly higher for patients who had an END (p = 0.037). The incidence of complications was not significantly different between the two groups.

Conclusions:

In light of the limited complications of an END and the poor prognosis of regional recurrence after previous (chemo)radiotherapy and a (pharyngo)laryngectomy, we advise consideration of an END at the time of a salvage laryngectomy.

Keywords:

Head and neck cancer Neck dissection Occult metastasis Salvage laryngectomy Squamous cell carcinoma

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