Effectiveness of Therapeutic Selective Neck Dissection in Laryngeal Cancer

Abstract

Background: The aim of this study was to evaluate the effectiveness of selective neck dissection (SND) in patients with laryngeal cancer and clinically positive cervical nodes. Subjects and Methods: A retrospective review of the clinical records of 58 consecutive untreated patients affected by laryngeal carcinoma and submitted to surgical treatment was performed. Results: Twenty-six (44.8%) patients received monolateral neck dissection and 32 (55.2%) bilateral neck dissection. A total of 90 hemineck dissections were performed. Histopathological examination revealed that 25 of the 58 patients had negative nodes (pN0) and 33 had positive nodes (pN+). Extracapsular spread was found in 12 of the 33 pN+ patients. Twenty-eight of the 58 (48.2%) patients were submitted to adjuvant radiotherapy. Six of the 58 patients submitted to neck dissection had neck recurrence (rate of 10.3%). The only independent prognostic factor for neck recurrence was extracapsular spread. For the 58 patients, the 5-year overall survival was 50% and the disease-specific survival 68.9%. The 5-year disease-specific survival was 76% for pN0 patients and 63.6% for pN+ patients. Conclusions: SND can represent a therapeutic procedure because it has shown oncological results comparable to those of comprehensive neck dissection, especially when SND is combined with adjuvant radiotherapy.

Analyses of High-Risk Factors for Cervical Lymph Node Metastasis in Laryngeal Squamous Cell Carcinoma and Establishment of Nomogram Prediction Model

“…Previous studies have reported that a large proportion of patients with LSCC who are clinically diagnosed with cervical LNM before operation and undergo cervical lymph node dissection during their operation have a negative pathological diagnosis after operation, which resulted in excessive treatment. 5 On the contrary, some clinically negative neck nodes are pathologically positive, leading to delay treatment or even a second operation. 6 Furthermore, indications for neck dissection and salvage laryngectomy for patients with LSCC without regional lymph node involvement before operation remain unclear.…”

Feasibility of Salvage Selective Neck Dissection after Primary Irradiation of Pharyngeal and Laryngeal Carcinoma

“…In 28 out of 29 (96%) NDs, the involved neck nodes were within the scope of SND, or there was no viable rest tumor. This less aggressive form of ND has been shown to carry minimal surgical morbidities but with comparable oncological outcomes [26]. Hanai et al[27] reported similar results in their study of N2–3 oropharyngeal and hypopharyngeal carcinoma patients: SND of levels II, III, and IV included 88% of positive neck nodes.…”

Submandibular Gland Transfer for the Prevention of Postradiation Xerostomia in Patients with Head and Neck Cancer: A Systematic Review and Meta-Analysis

“…More than 95% of head-and-neck cancers are squamous cell carcinomas, suggesting that it is a homogeneous neoplasm when compared with other types of tumors [2]. Generally, using surgery combined with neck dissection, the gross tumor can be removed; however, the main difficulty for the surgeons lies in the residual of the microscopic tumor beyond the surgical margins, which causes recurrence after surgery [3]. So, for the most locally advanced head-and-neck cancers, radiotherapy either alone or postoperatively may achieve the optimal result because radiotherapy may kill the present or remaining cancer cells.…”