We would like to thank Reddy et al. 1 for thoroughly reading our article, "Elective Neck Dissection During Salvage Laryngectomy: A Systematic Review and Meta-Analysis" 2 and providing feedback. To clarify patients' pretreatment nodal status, 803 of 1,149 (70%) were N0 on initial presentation prior to definitive (chemo) radiation; 61 (5%) were N+; and 285 (25%) were not reported. Radiation treatment fields were not consistently described. After presenting with a recurrence, the decision to perform elective neck dissection (END) versus observation was either variable or not reported. Our systematic review and meta-analysis was published in the same year as two other systematic reviews and meta-analyses on the same topic. 3,4 Our literature review was performed the most recently and was therefore able to include articles from 2018 and 2019. Overall, many of the same studies were included in each review, and our calculated 11% occult nodal rate is similar to their 13.7% and 14%. We previously did not publish the different rates of occult nodal positivity between recurrent laryngeal subsites and tumor stages, but we describe them here. We calculated a pooled occult nodal rate of 11% (95% CI 7-14) in glottic tumors, 23% (95% CI 14-33) in supraglottic tumors, 10% (95% CI 6-14) in T1-T2 tumors, and 16% (95% CI 11-21) in T3-T4 tumors. Our systematic review demonstrates that recurrent supraglottic subsite and advanced T-stage have an increased rate of occult nodal disease. However, patients with recurrent or persistent cancer in a (chemo) irradiated field express significant molecular alterations, biologic changes, and risk of clonal resistance, with a poorer overall prognosis. Most importantly, does END confer a survival advantage over observation in these patients? We were only able to include a few studies for meta-analyses to address this question. Due to excessive heterogeneity and insufficient data, we could not make meaningful conclusions in disease-free survival or 2-year overall survival (OS) differences. Based on only three included studies, we did not find significant differences in 5-year OS. These conclusions are based upon mostly retrospective, single-institution studies; thus, future prospective studies are needed for clarification. We agree that it is not unreasonable to proceed with END in patients with recurrent supraglottic tumors, possibly in patients with advanced stage tumors, and in those without significant morbidity or advanced age. However, the survival benefit is still unclear, and there is a potential increased risk of postoperative complication. As a result, we believe the decision to perform a salvage END remains challenging and imprecise, and it should be made on an individual basis.