Is elective neck dissection necessary in cases of laryngeal recurrence after previous radiotherapy for early glottic cancer?

AbstractObjectives:To assess the clinical utility of elective neck dissection in node-negative recurrent laryngeal carcinoma after curative radiotherapy for initial early glottic cancer.Methods:A retrospective review was undertaken of 110 consecutive early glottic cancer patients who developed laryngeal recurrence after radiotherapy (34 recurrent T1, 36 recurrent T2, 29 recurrent T3 and 11 recurrent T4a) and received salvage laryngeal surgery between 1995 and 2005.Results:Six patients presented with laryngeal and neck recurrence and underwent salvage laryngectomy with therapeutic neck dissection, 97 patients with recurrent node-negative tumours underwent salvage laryngeal surgery without neck dissection and only 7 underwent elective neck dissection. No occult positive lymph nodes were documented in neck dissection specimens. During follow up, only three patients with neck failure were recorded, all in the group without neck dissection. There was no significant association between the irradiation field (larynx plus neck vs larynx) and the development of regional failure. A higher rate of post-operative pharyngocutaneous fistula development occurred in the neck dissection group than in the group without neck dissection (57.2 per cent vs 13.4 per cent, p = 0.01). Multivariate logistic regression analysis showed that early (recurrent tumour-positive, node-positive) or delayed (recurrent tumour-positive, node-negative) neck relapse was not significantly related to the stage of the initial tumour or the recurrent tumour. An age of less than 60 years was significantly associated with early neck failure (recurrent tumour-positive, node-positive).Conclusion:Owing to the low occult neck disease rate and high post-operative fistula rate, elective neck dissection is not recommended for recurrent node-negative laryngeal tumours after radiation therapy if the initial tumour was an early glottic cancer.

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Should elective neck dissection be routinely performed in patients undergoing salvage total laryngectomy?

The Journal of Laryngology & Otology ◽

10.1017/s0022215114000425 ◽

2014 ◽

Vol 128 (3) ◽

pp. 279-283 ◽

Cited By ~ 15

Author(s):

T F Pezier ◽

I J Nixon ◽

W Scotton ◽

A Joshi ◽

T Guerrero-Urbano ◽

...

Keyword(s):

Neck Dissection ◽

Total Laryngectomy ◽

Elective Neck Dissection ◽

Retrospective Case ◽

Node Negative ◽

Node Positive ◽

Tertiary Centre ◽

Post Surgery ◽

Radiological Staging ◽

Primary Radiotherapy

AbstractBackground:The prevalence of occult neck metastasis in patients undergoing salvage total laryngectomy remains unclear, and there is controversy regarding whether elective neck dissection should routinely be performed.Method:A retrospective case note review of 32 consecutive patients undergoing salvage total laryngectomy in a tertiary centre was performed, in order to correlate pre-operative radiological staging with histopathological staging.Results:The median patient age was 61 years (range, 43–84 years). With regard to lymph node metastasis, 28 patients were pre-operatively clinically staged (following primary radiotherapy or chemoradiotherapy) as node-negative, 1 patient was staged as N1, two patients as N2c and one patient as N3. Fifty-two elective and seven therapeutic neck dissections were performed. Pathological analysis up-staged two patients from clinically node-negative (following primary radiotherapy or chemoradiotherapy) to pathologically node-positive (post-surgery). No clinically node-positive patients were down-staged. More than half of the patients suffered a post-operative fistula.Conclusion:Pre-operative neck staging had a negative predictive value of 96 per cent. Given the increased complications associated with neck dissection in the salvage setting, consideration should be given to conservative management of the neck in clinically node-negative patients (staged following primary radiotherapy or chemoradiotherapy).

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Cost-effectiveness analysis of elective neck dissection in patients with clinically node negative oral cavity cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.15_suppl.e18275 ◽

2016 ◽

Vol 34 (15_suppl) ◽

pp. e18275-e18275

Author(s):

Joseph Roy Acevedo ◽

Katherine Elaine Fero ◽

Bayard R Wilson ◽

Charles Coffey ◽

James Don Murphy

Keyword(s):

Cost Effectiveness ◽

Oral Cavity ◽

Neck Dissection ◽

Oral Cavity Cancer ◽

Cost Effectiveness Analysis ◽

Elective Neck Dissection ◽

Node Negative ◽

Effectiveness Analysis

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Faculty Opinions recommendation of Outcome after elective neck dissection and observation for the treatment of the clinically node-negative neck (cN0) in squamous cell carcinoma of the oropharynx.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718008994.793492341 ◽

2014 ◽

Author(s):

Heikki Irjala

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Neck Dissection ◽

Squamous Cell ◽

Elective Neck Dissection ◽

Node Negative

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Regional Failures after Selective Neck Dissection in Previously Untreated Squamous Cell Carcinoma of Oral Cavity

International Journal of Surgical Oncology ◽

10.1155/2014/205715 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Hassan Iqbal ◽

Abu Bakar Hafeez Bhatti ◽

Raza Hussain ◽

Arif Jamshed

Keyword(s):

Squamous Cell Carcinoma ◽

Oral Cavity ◽

Cell Carcinoma ◽

Neck Dissection ◽

Squamous Cell ◽

Treatment Modalities ◽

Selective Neck Dissection ◽

Node Negative ◽

Node Positive ◽

Regional Control

Aim. To share experience with regional failures after selective neck dissection in both node negative and positive previously untreated patients diagnosed with squamous cell carcinoma of the oral cavity.Patients and Methods. Data of 219 patients who underwent SND at Shaukat Khanum Cancer Hospital from 2003 to 2010 were retrospectively reviewed. Patient characteristics, treatment modalities, and regional failures were assessed. Expected 5-year regional control was calculated and prognostic factors were determined.Results. Median follow-up was 29 (9–109) months. Common sites were anterior tongue in 159 and buccal mucosa in 22 patients. Pathological nodal stage was N0 in 114, N1 in 32, N2b in 67, and N2c in 5 patients. Fourteen (6%) patients failed in clinically node negative neck while 8 (4%) failed in clinically node positive patients. Out of 22 total regional failures, primary tumor origin was from tongue in 16 (73%) patients. Expected 5-year regional control was 95% and 81% for N0 and N+ disease, respectively (P<0.0001). Only 13% patients with well differentiated, T1 tumors in cN0 neck were pathologically node positive.Conclusions. Selective neck dissection yields acceptable results for regional management of oral squamous cell carcinoma. Wait and see policy may be effective in a selected subgroup of patients.

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Partial Vertical Laryngectomy in the Treatment of Early Glottic Cancer

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949810700709 ◽

1998 ◽

Vol 107 (7) ◽

pp. 593-597 ◽

Cited By ~ 18

Author(s):

Tzung-Shiahn Sheen ◽

Jenq-Yuh Ko ◽

Yen-Liang Chang

Keyword(s):

Neck Dissection ◽

Glottic Cancer ◽

Salvage Operation ◽

Early Glottic Cancer ◽

Larynx Preservation ◽

Neck Recurrence ◽

Group 5 ◽

Lost To Follow Up ◽

Recurrence Group

Treatment of early glottic cancer is still controversial. A retrospective study was conducted to analyze the results of 49 partial vertical laryngectomies in our department. All patients except 1 were successfully decannulated. The quality of voice was suboptimal but serviceable in all patients. Overall, there were 9 recurrences: 7 in the larynx and 2 in the neck. In the laryngeal recurrence group, 5 of 6 patients were successfully salvaged with total laryngectomy. One patient died of acute renal failure 1 month after salvage operation. Another patient survived 4.5 years after cisplatin-based chemotherapy. In the neck recurrence group, 1 patient was successfully salvaged with neck dissection; the other was lost to follow-up after neck dissection. The actuarial 5-year survival rate was 97.4% and the larynx preservation rate was 88%. The recurrence rate was 14%, when 2 of the 7 laryngeal recurrences were excluded because they occurred beyond 5 years. The results of this series were encouraging. We suggest that partial vertical laryngectomy is a good treatment modality for selected early glottic cancers, especially those of the T1 group.

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Is routine neck dissection warranted at salvage laryngectomy?

The Journal of Laryngology & Otology ◽

10.1017/s0022215121001808 ◽

2021 ◽

pp. 1-6

Author(s):

S Sharma ◽

D A Chaukar ◽

M Bal ◽

A K D'Cruz

Keyword(s):

Neck Dissection ◽

Residual Disease ◽

Multivariable Analysis ◽

Nodal Metastasis ◽

Elective Neck Dissection ◽

Occult Metastasis ◽

Initial Node ◽

Node Positive ◽

Node Positive Disease ◽

Salvage Laryngectomy

Abstract Background There is controversy regarding management of the neck at salvage laryngectomy. The aim of this study was to perform an analysis to determine the incidence of occult node positivity in this group and analyse factors affecting it. Method A retrospective analysis of 171 patients who underwent salvage total laryngectomy between 2000 and 2015 for recurrent or residual disease following definitive non-surgical treatment and were clinico-radiologically node negative at the time salvage laryngectomy was carried out. Results A total of 171 patients with laryngeal or hypopharyngeal cancers underwent concurrent neck dissection at laryngectomy. There were 162 patients (94.7 per cent) who underwent bilateral neck dissection, and 9 patients (5.3 per cent) who underwent ipsilateral neck dissection. The occult lateral nodal metastasis rate was 10.5 per cent. Of various factors, initial node positive disease was the only factor predicting occult metastasis on univariable and multivariable analysis (p = 0.001). Conclusion Risk of occult metastasis is high in patients who have node positive disease before starting radiotherapy. This group should be offered elective neck dissection.

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Elective Neck Dissection can Improve the Overall Survival and Cancer-Specific Survival of T3cN0M0 Glottic Squamous Cell Cancer

10.21203/rs.3.rs-706888/v1 ◽

2021 ◽

Author(s):

Zhimou Cai ◽

Lin Chen ◽

Jiangwei Zhang ◽

Yihui Wen ◽

Wen-bin Lei

Keyword(s):

Overall Survival ◽

Neck Dissection ◽

Squamous Cell ◽

Squamous Cell Cancer ◽

Cell Cancer ◽

Elective Neck Dissection ◽

Cancer Specific Survival ◽

Node Negative ◽

Considerable Discussion

Abstract How to treat clinically node-negative (cN0) neck in larynx squamous cell cancer (LSCC) has been subject to considerable discussion. The role of elective neck dissection (END) in patients with T3 glottic squamous cell cancer (GSCC) with cN0 is remain unclear. The objective of this study is to elucidate the role of END in improve the outcome of T3cN0M0 GSCC. Patients with T3cN0M0 GSCC in the Surveillance, Epidemiology, and End Results database (SEER) from 2004 to 2015 were extracted and stratified into END and Non-END cohorts, we found that only 22–58% T3cN0M0 GSCC were performed with END. After Propensity score matching (PSM), END cohort had better overall survival (OS) (median survival time: 93 vs 40 months, respectively; p < 0.0001) and cancer-specific survival (CSS) (HR 0.40, 95%CI 0.26 to 0.64, p = 0.0012) than non-END cohort. In addition, Subgroup analysis also indicated END cohort had better OS or CSS than non-END cohort.This study demonstrated that in patients with T3cN0M0 GSCC, END significantly associated with better survival outcomes compared with non-END.

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