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Is routine neck dissection warranted at salvage laryngectomy?
S Sharma1, D A Chaukar2, M Bal3
1Department of Head Neck Surgical Oncology, Narayana Superspeciality Hospital, Gurugram, India.
The Journal of Laryngology and Otology
|July 9, 2021
Summary
Salvage laryngectomy patients with prior node-positive disease have a high risk of occult metastasis. Elective neck dissection is recommended for these patients to improve outcomes.
Area of Science:
- Oncology
- Head and Neck Surgery
- Laryngology
Background:
- Management of the neck in salvage laryngectomy remains controversial.
- Determining the incidence of occult nodal positivity is crucial for guiding treatment decisions.
Purpose of the Study:
- To analyze the incidence of occult node positivity in patients undergoing salvage laryngectomy.
- To identify factors influencing occult metastasis in this patient cohort.
Main Methods:
- Retrospective analysis of 171 patients undergoing salvage total laryngectomy (2000-2015).
- Inclusion criteria: recurrent/residual disease post-non-surgical treatment, clinico-radiologically node-negative at salvage.
- Concurrent neck dissection performed in all patients.
Main Results:
- Occult lateral nodal metastasis rate was 10.5% in 171 patients.
- Initial node-positive disease was the sole predictor of occult metastasis (p=0.001).
- Bilateral neck dissection was performed in 94.7% of cases.
Conclusions:
- Patients with prior node-positive disease face a significant risk of occult metastasis.
- Elective neck dissection should be considered for patients with a history of node-positive disease.
- This approach may improve oncological control in salvage laryngectomy settings.
