Elective neck dissection in patients with radio‐recurrent and radio‐residual squamous cell carcinoma of the larynx undergoing salvage total laryngectomy: Systematic review and meta‐analysis

Lin, Daniel J.; Lam, Alyson; Warner, Laura; Paleri, Vinidh

doi:10.1002/hed.25907

Cited by 17 publications

(20 citation statements)

References 30 publications

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“…However, two recent meta-analyses have failed to show either that neck dissection increases the risk of pharyngocutaneous fistula or that neck dissection provides a clear survival benefit. 19,20 The main argument against an elective neck dissection is that even in advanced recurrences, the rate of pathologically confirmed occult metastases does not exceed 10 per cent, and this is accompanied by an increased risk of complications. 5,21…”

Section: Discussionmentioning

confidence: 99%

Twenty-year experience with salvage total laryngectomy: lessons learned

et al. 2021

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Objective The purpose of this study was to evaluate the outcome of salvage total laryngectomy and identify areas for further improvement. Method A retrospective analysis of all patients who underwent salvage total laryngectomy between January 1999 and December 2018 was performed. Results Thirty-one patients were identified. The most common primary tumour site was the glottis (83.8 per cent). Early stage (T1–T2) disease was identified in 83.9 per cent of cases. Overall survival at 2 and 5 years post-salvage total laryngectomy was 71 per cent and 45 per cent, respectively. Disease-free survival at 2 and 5 years post-salvage total laryngectomy was 65 per cent and 42 per cent, respectively. The rate of post-salvage total laryngectomy pharyngocutaneous fistula was 29 per cent. Conclusion More than half of patients will not survive beyond five years after salvage total laryngectomy. Regional recurrence was the most common form of failure and death. From this study, elective lateral and central neck dissection is advocated in patients with early laryngeal cancer who present with an advanced recurrence.

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Section: Discussionmentioning

confidence: 99%

Twenty-year experience with salvage total laryngectomy: lessons learned

et al. 2021

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“…Neck dissection may be avoided in patients with a N0 neck at the time of both the initial treatment and salvage surgery. In this situation, neck dissection could enhance the postoperative complication rate and functional impairment without a demonstrated benefit in terms of survival [13,32]. More controversial is the indication of neck dissection in patients with N+ neck at the time of initial treatment who are N0 (TEP scan evaluation) at the time of laryngeal tumor recurrence.…”

Section: Total Laryngectomy As a Salvage Surgical Proceduresmentioning

confidence: 99%

“…This is a relatively rare situation, and each strategy (neck dissection or not) is associated with several advantages and drawbacks. Neck dissection offers an opportunity to remove possible microscopic residual disease in the lymph nodes but exposes the patient to an increased risk of postoperative complications [13,32,33].…”

Section: Total Laryngectomy As a Salvage Surgical Proceduresmentioning

confidence: 99%

Current Role of Total Laryngectomy in the Era of Organ Preservation

Bozec

Culié

Poissonnet

et al. 2020

Cancers

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In this article, we aimed to discuss the role of total laryngectomy (TL) in the management of patients with larynx cancer (LC) in the era of organ preservation. Before the 1990s, TL followed by radiotherapy (RT) was the standard treatment for patients with locally advanced LC. Over the last 30 years, various types of larynx preservation (LP) programs associating induction or concurrent chemotherapy (CT) with RT have been developed, with the aim of treating locally advanced LC patients while preserving the larynx and its functions. Overall, more than two-thirds of patients included in a LP program will not require total laryngectomy (TL) and will preserve a functional larynx. However, despite these advances, the larynx is the only tumor site in the upper aero-digestive tract for which prognosis has not improved during recent decades. Indeed, none of these LP protocols have shown any survival advantage compared to primary radical surgery, and it appears that certain LC patients do not benefit from an LP program. This is the case for patients with T4a LC (extra-laryngeal tumor extension through the thyroid cartilage) or with poor pretreatment laryngeal function and for whom primary TL is still the preferred therapeutic option. Moreover, TL is the standard salvage therapy for patients with recurrent tumor after an LP protocol.

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“…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%.…”

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confidence: 99%

In Response to Letter to the Editor Regarding: Elective Neck Dissection During Salvage Laryngectomy: A Systematic Review and Meta‐Analysis

et al. 2020

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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.

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Elective neck dissection in patients with radio‐recurrent and radio‐residual squamous cell carcinoma of the larynx undergoing salvage total laryngectomy: Systematic review and meta‐analysis

Cited by 17 publications

References 30 publications

Twenty-year experience with salvage total laryngectomy: lessons learned

Twenty-year experience with salvage total laryngectomy: lessons learned

Current Role of Total Laryngectomy in the Era of Organ Preservation

In Response to Letter to the Editor Regarding: Elective Neck Dissection During Salvage Laryngectomy: A Systematic Review and Meta‐Analysis

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