Elective Paratracheal Lymph Node Dissection in Salvage Laryngectomy

Area of Science:

• Oncology
• Surgical Oncology
• Head and Neck Cancer

Background:

• Indications and efficacy of paratracheal nodal dissection (PTND) in salvage laryngectomy for persistent or recurrent laryngeal squamous cell carcinoma are not well-defined.
• Laryngeal cancer recurrence after initial treatment necessitates salvage surgery, often involving laryngectomy.
• The role of PTND in managing the neck in these complex cases requires further clarification.

Purpose of the Study:

• To evaluate the indications and outcomes of paratracheal nodal dissection (PTND) in patients undergoing salvage laryngectomy.
• To determine the association between PTND and survival in patients with recurrent laryngeal cancer.
• To assess the incidence of occult paratracheal metastases and the impact on hypocalcemia.

Main Methods:

• Retrospective cohort study of 210 patients undergoing salvage laryngectomy with clinically and radiographically negative neck disease (1998-2015).
• Univariate and multivariate Cox regression analyses were performed to assess survival outcomes.
• Comparison of outcomes between patients who underwent PTND and those who did not.

Main Results:

• PTND was performed in 36% of patients, more frequently in those with advanced T classification (rT3/rT4) tumors.
• Occult nodal metastases in the paratracheal basin were found in 14% of patients, often without lateral neck disease.
• PTND was associated with improved overall survival (OS), disease-free survival (DFS), and distant DFS (p < 0.05).
• Hypocalcemia rates did not differ significantly between groups.

Conclusions:

• Paratracheal nodal dissection during salvage laryngectomy is indicated for advanced tumors (rT3/rT4) and is associated with improved survival outcomes.
• PTND can identify occult paratracheal metastases that may be independent of lateral neck disease.
• The procedure does not adversely affect calcium levels, suggesting it is a safe addition to salvage laryngectomy.