Occult nodal disease in patients with failed laryngeal preservation undergoing surgical salvage

Koss, Shira; Russell, Marika D.; Leem, Ted H.; Schiff, Bradley A.; Smith, Richard V.

doi:10.1002/lary.24005

Cited by 42 publications

(49 citation statements)

References 27 publications

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“…Although some authors have argued against routine neck dissection in the salvage setting when there is no clinical evidence of disease because of morbidity concerns, we performed neck dissections on the majority of the patients (82%), and most were bilateral neck dissections encompassing levels 2 to 4, medial 5, or extended when clinical disease was evident. The pathologic findings did show node positivity in 25% of the patients after the neck dissections, consistent with other reports in the literature showing a concern for occult nodal disease in patients with failed laryngeal preservation who underwent surgical salvage, particularly if the supraglottis or transglottic subsites were observed …”

Section: Discussionsupporting

confidence: 90%

Elucidation of salvage laryngectomy pathologic and clinical variables to guide further treatment intensification investigation

et al. 2017

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Section: Discussionsupporting

confidence: 90%

Elucidation of salvage laryngectomy pathologic and clinical variables to guide further treatment intensification investigation

et al. 2017

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“…Despite contacting and receiving replies from most of the authors, multiple studies did not have the individual data points required to calculate OS and DFS for meta‐analysis. As a result, only three studies (including 103 elective necks and 52 observed) were used for the meta‐analysis for OS . Meaningful DFS could not be calculated due to insufficient data.…”

Section: Resultsmentioning

confidence: 99%

“…The application of this decision tree to the salvage setting is more unclear, however. Looking specifically at the included studies by Birkeland et al, Wax and Touma, Yao et al, and Koss et al, they report a ≥20% risk of occult nodal disease with recurrent supraglottic tumors and advanced tumor (T) stage (T3–T4) tumors and therefore recommend END for those subsets . Based on the existing standard and the above data, it may be reasonable to observe the necks of a recurrent laryngeal cancer unless it is an advanced T stage or of supraglottic subset.…”

Section: Discussionmentioning

confidence: 99%

Elective neck dissection during salvage laryngectomy: A systematic review and meta‐analysis

Gross

Vila

Simón³

et al. 2019

The Laryngoscope

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Objectives The primary objective was to determine the rate of occult cervical nodal metastasis in patients undergoing elective neck dissection (END) during salvage laryngectomy. The secondary objective was to compare survival and postoperative complication rates between patients undergoing END versus observation. Methods A medical librarian performed a comprehensive search for END outcomes in laryngeal cancer patients undergoing salvage laryngectomy after primary chemoradiation therapy. Seventeen retrospective studies and 1 prospective study met inclusion criteria, with a total of 1,141 patients (799 END, 350 observed). Results The rate of nodal positivity was 11% among patients who underwent END during their salvage laryngectomy. Three studies and 155 patients were included in a 5‐year overall survival (OS) analysis with no significant difference in OS (95% confidence interval [CI]: 0.82‐2.22). After inclusion of six studies and 494 patients (249 END, 245 observed), the risk of fistula formation was not statistically different (95% CI: 0.61‐2.56). Due to significant heterogeneity between studies and inadequate data, most patients could not be included in the meta‐analysis of outcomes. Conclusion Salvage laryngectomy patients undergoing END have an occult nodal positivity rate of 11%. Meta‐analysis showed no statistically significant differences in 5‐year OS between patients undergoing END versus observation. Laryngoscope, 130:899–906, 2020

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“…By contrast, Wax and Touma (25) and Yao et al (26) recommended neck dissection in recurrent supraglottic carcinoma and advanced (rT3-T4) disease. Koss et al (30) suggested that STL with neck dissection improved survival compared to STL alone in recurrent laryngeal SCC.…”

Section: Discussionmentioning

confidence: 99%

Management of the N0 neck in recurrent laryngeal squamous cell carcinoma

Jin

2015

Molecular and Clinical Oncology

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Abstract. The most effective therapeutic approach for the node-negative (N0) neck in patients with recurrent laryngeal squamous cell carcinoma (SCC) remains a subject of dispute. In the present study, the records of 163 patients with recurrent laryngeal SCC were retrospectively reviewed. All patients had a N0 neck at recurrence. At the time of recurrence, the N0 neck was managed using a wait-and-see strategy (observation group) or treatment (treatment group). A total of 125 (76.7%) patients accepted the wait-and-see strategy and 38 (23.3%) patients underwent treatments, including surgery, radiotherapy and/or chemotherapy. The Kaplan-Meier method with the computation of log-rank was used for analysis of survival. The t-test, χ 2 test or Fisher's exact test was used for comparisons of non-survival data in the groups. P<0.05 was considered to indicate a statistically significant difference in the two-sided tests. The 3-and 5-year overall survival rates after recurrence were 64.5 and 54.6% for the observation group, and 49.9 and 42.5% for the treatment group, respectively (P=0.011). The present study suggests that a wait-and-see policy is a satisfactory management option for the N0 neck in recurrent laryngeal SCC.

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Occult nodal disease in patients with failed laryngeal preservation undergoing surgical salvage

Abstract: 4.

Cited by 42 publications

References 27 publications

Elucidation of salvage laryngectomy pathologic and clinical variables to guide further treatment intensification investigation

Elucidation of salvage laryngectomy pathologic and clinical variables to guide further treatment intensification investigation

Elective neck dissection during salvage laryngectomy: A systematic review and meta‐analysis

Management of the N0 neck in recurrent laryngeal squamous cell carcinoma

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