Is elective contralateral neck dissection necessary in 53 salvage total laryngectomy patients?

Abstract

Historically, if the risk of occult nodal disease is >20%, elective neck dissection was advised for surgical management of squamous cell carcinoma (SCC). 1,2 A recent meta-analysis in the salvage laryngectomy setting (n = 1141) reported an occult nodal positivity rate (cN0pN+) of 11%, 3 which was higher in advanced local supraglottic (24%) or transglottic (17%) disease. Therefore, in high-risk patients undergoing salvage laryngectomy, neck dissection is generally recommended.The cN0pN+ disease rate in the contralateral neck in salvage total laryngectomy remains unclear and studies have shown neck dissection does not improve locoregional control or overall survivial. [4][5][6] The primary aim of this study is to report the rate of nodal metastases in the contralateral neck for patients undergoing salvage laryngectomy and to identify predictors of occult neck disease. | MATERIAL AND ME THODS | Ethical considerationsData were collected with Caldicott guardian approval (ref 16111). The South East Scotland Research Ethics committee waived the need for formal ethical approval due to the retrospective nature of data collection.

Patterns of neck metastasis and occult neck disease during recurrent laryngeal cancer

“…Hogg et al . 22 reported a 2 per cent risk of contralateral neck disease during salvage total laryngectomy, and therefore recommended avoiding contralateral elective neck dissection during salvage total laryngectomy. In our series, no patient had involvement of levels I or V, and only one patient with a lateralised tumour had contralateral neck disease.…”

“…To date, the only large series reporting the risk of occult neck disease in a specific neck level according to primary tumour location (but not recurrent stage) 20 showed that the risk of occult neck disease at levels I, IV and V for supraglottic SCC and all levels for glottis SCC (except level VI) was less than 10 per cent, whereas the risk of occult neck disease at levels II, III and VI for supraglottic SCC is more than 10 per cent even on the contralateral side. Hogg et al 22 reported a 2 per cent risk of contralateral neck disease during salvage total laryngectomy, and therefore recommended avoiding contralateral elective neck dissection during salvage total laryngectomy. In our series, no patient had involvement of levels I or V, and only one patient with a lateralised tumour had contralateral neck disease.…”