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  1. Home
  3. Elective Neck Dissection In Patients Undergoing Salvage Laryngectomy: Outcomes, Complications, And Considerations.
  1. Home
  3. Elective Neck Dissection In Patients Undergoing Salvage Laryngectomy: Outcomes, Complications, And Considerations.

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Elective Neck Dissection in Patients Undergoing Salvage Laryngectomy: Outcomes, Complications, and Considerations.

Nickolas A Alsup1, Soroush Farsi1, Sydney K Blevins1

  • 1Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, USA.

Cureus
|June 13, 2024

View abstract on PubMed

Summary
This summary is machine-generated.

Advanced recurrent tumor stage predicts occult nodal disease in salvage laryngectomy patients. Elective neck dissection did not improve outcomes but should include lateral neck dissection if performed.

Keywords:
elective neck dissectionoccult nodal diseaseoutcomesrecurrencesalvage total laryngectomysurvival

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Area of Science:

  • Otolaryngology
  • Head and Neck Surgery
  • Surgical Oncology

Background:

  • Occult nodal disease (OND) is a concern in patients undergoing salvage laryngectomy (SLE) with clinically node-negative (cN0) necks.
  • Predictors for OND and the impact of elective neck dissection (END) on oncologic outcomes require further investigation.

Purpose of the Study:

  • To identify predictors of OND in cN0 patients undergoing SLE.
  • To compare oncologic outcomes between patients who received END and those managed with observation.

Main Methods:

  • Retrospective chart review of 58 patients undergoing SLE with cN0 necks over 12 years.
  • Patients were divided into END (n=39) and observation (n=19) groups.
  • Univariate and survival analyses (log-rank test) were used to assess OND, regional recurrence-free survival (RRFS), and disease-specific survival (DSS).

Main Results:

  • Five of 71 (7%) neck dissection specimens showed pathological nodal disease, primarily in levels II-IV.
  • Advanced recurrent T-stage (rT3-rT4) was the only significant predictor of OND (p=0.017).
  • No significant differences in perioperative complications, RRFS (p=0.216), or DSS (p=0.298) were observed between END and observation groups.

Conclusions:

  • Advanced recurrent T-stage (rT3-rT4) predicts OND in cN0 necks undergoing SLE.
  • If END is performed, formal lateral neck dissection is recommended due to OND involvement in levels II-IV.
  • END did not improve loco-regional control or survival compared to observation in this cohort.