Elective Neck Dissection during Salvage Total Laryngectomy: Personal Experience

Area of Science:

• Otolaryngology
• Surgical Oncology
• Head and Neck Cancer Research

Background:

• The necessity of elective neck dissection in salvage surgery for clinically node-negative (cN0) recurrent laryngeal cancer remains debated.
• Understanding occult metastasis prevalence and predictive factors is crucial for optimizing treatment strategies in these patients.

Purpose of the Study:

• To determine the prevalence and predictive factors of occult lymph node metastasis in cN0 patients undergoing salvage total laryngectomy.
• To evaluate survival rates and oncologic outcomes following salvage total laryngectomy with elective bilateral neck dissection in cN0 patients.

Main Methods:

• Retrospective observational study involving 80 cN0 patients with recurrent laryngeal cancer.
• Patients underwent salvage total laryngectomy and bilateral selective elective neck dissection.
• Data analysis included identification of prognostic factors, review of postoperative complications, and survival analysis (Overall Survival, Disease-Specific Survival, Recurrence-Free Survival).

Main Results:

• Occult lymph node metastases were identified in 22.5% (18 out of 80) of patients.
• Lymphovascular invasion (p = 0.007) and perineural invasion (p = 0.025) were significant predictors of occult nodal metastasis.
• Five-year Overall Survival, Disease-Specific Survival, and Recurrence-Free Survival rates were 50.4%, 64.7%, and 63.4%, respectively.

Conclusions:

• Routine elective selective bilateral neck dissection is suggested during salvage total laryngectomy for cN0 patients due to the tumor's propensity for cervical spread.
• This surgical approach is associated with an acceptable rate of postoperative complications.
• The findings support the routine use of elective neck dissection in this patient population to improve oncologic outcomes.