Is Bilateral Neck Dissection Necessary in N0 Necks in Laryngeal Cancer? In the Same Session, or Staged Surgery?

Abstract

Metastatic nodal disease is the most important prognostic factor in laryngeal cancer as in the other head and neck cancers. 1 Histologically identified regional metastasis is correlated with an increased risk for recurrence, and approximately 50% decrease in survival. 2 Although the incidence of occult neck metastasis varies in relation with localization, stage, and differentiation of the laryngeal cancer, occult neck metastasis was reported as 30% in supraglottic laryngeal cancer, and 20% in T3-T4 glottic laryngeal ABS TRACT Objective: In this study, we aimed to determine ipsilateral and contralateral occult neck metastasis rate in patients who underwent bilateral neck dissection due to T1-T4 N0 laryngeal carcinoma, and put forward the need for bilateral neck dissection. Material and Methods: This study included 60 patients who underwent bilateral neck dissections due to T1-T4 N0 laryngeal carcinoma between 1998 and 2015. The patients were divided into three groups according to the localization of the tumor (supraglottic, glottic, and transglottic). Each group was divided into 3 subgroups as unilateral lesion, midline lesion, and unilateral lesion passing across the midline. The neck metastases were classified as ipsilateral, contralateral, or bilateral. Results: The tumor was supraglottic in 14, glottic in 13, and transglottic in 33 patients. There was neck metastasis in 9 of 60 patients (3 patients had N1, 3 patients had N2b, and 3 patients had N2c necks). Contralateral neck metastasis was not seen in any of the patients with unilateral tumors. Contralateral neck metastasis was not evident when there was not an ipsilateral neck metastasis. The rate of contralateral neck metastasis in presence of ipsilateral neck metastasis was 33% in supraglottic, 50% in glottic T4a, and 25% in transglottic tumors. Conclusion: The results of this study indicated that unilateral neck dissection was sufficient in all groups in case of unilateral tumors, and unilateral tumors passing across the midline when there is no ipsilateral neck metastasis, but bilateral neck dissection is needed in midline tumors.