Role of neck dissections in patients undergoing salvage laryngectomy with a clinically and radiologically negative neck

Abstract

Routine ND for clinically and radiologically N0 neck in recurrent laryngeal SCC after previous RT or CRT remains debatable. Recorded incidence of occult nodal metastasis after STL plus ND in literature varies from 0% to 28.3%. Numerous studies unsuccessfully demonstrated survival benefit with ND, while others recorded benefit for some patients. Some studies recorded higher morbidity rate with ND, whereas others recorded non-significant difference. The present study is to the best of our knowledge the first prospective analysis to date aiming at revealing the effect of performance of ND during salvage laryngectomy on regional recurrence, morbidity and survival. A prospective chart review was achieved on 23 salvage laryngectomy patients who were clinically and radiologically N0 preoperatively. Performing ND and other factors were tested for associations with reginal recurrence, different postoperative complications, overall and disease free survival. Twelve patients underwent ND, from whom 2 had positive nodal pathology. ND was significantly associated increased overall complications with no significantly improved regional control and survival outcomes. Positive nodal pathology was associated with worst survival on multivariate analysis. Outcomes advise to refrain from the imperative performance of neck dissection in all patients. END may be spared for late stages supra-glottic tumors and T4 glottic tumors.