Treatment of the clinically negative neck in laryngeal cancer patients

Elective treatment of the NO neck in patients with laryngeal cancer remains a controversial issue. We reviewed our experience with patients who had neck dissection for NO laryngeal carcinoma with occult metastases in order to compare elective lymphadenectomy results with those achieved with therapeutic neck dissection performed subsequently when occult disease became clinically evident.

We retrospectively analyzed 150 NO laryngeal cancer patients who after a neck dissection had histologically positive lymph nodes and 5-year minimum follow-up. This population was divided in two subsets, including: 54 NO patients with occult neck metastases who had an elective neck surgery (ED); 96 initially NO patients who had a subsequent therapeutic neck dissection when nodal involvement became clinically detectable (STD). The two groups were compared with respect to the pattern of nodal metastasis and sites of treatment failures and also in terms of absolute, determinate, and actuarial survival.

Overall absolute survival was 72.2% in the elective dissected (ED) group, compared with 54.1% in the group of subsequent therapeutic dissected (STD) patients (p = 0.075). Determinate survival was 74.0% after ED and 59.3% after STD (p = 0.17). Actuarial curves by the Kaplan-Meier method did not show any statistically significant differences among the two groups analyzed (logrank test, p = 0.54). Accordingly, Cox multivariate analysis confirmed that neck treatment policy had no prognostic impact on survival in our NO laryngeal cancer patients. However, a higher proportion of STD patients died of metastases at distant sites compared with ED patients (21.9% vs 7.4%, respectively) (p = 0.02).

Elective lymphadenectomy does not significantly improve survival in NO laryngeal cancer patients with occult disease compared with those undergoing a therapeutic neck dissection when metastases subsequently appear.