Should elective neck dissection be routinely performed in patients undergoing salvage total laryngectomy?

Pézier, Thomas F.; Nixon, Iain J.; Scotton, William; Joshi, Avinash R; Urbano, Teresa Guerrero; Oakley, Richard; Jeannon, Jean‐Pierre; Simó, Ricard

doi:10.1017/s0022215114000425

Cited by 31 publications

(45 citation statements)

References 39 publications

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“…The role of elective neck dissection during STL remains unclear. Although some authors have illustrated improved survival outcomes with elective neck dissection, others have demonstrated no benefit . In our cohort, the rate of occult nodal disease among patients who underwent neck dissection in the absence of preoperative clinically evident nodal burden was 5%.…”

Section: Discussionmentioning

confidence: 52%

Salvage total laryngectomy after external‐beam radiotherapy: A 20‐year experience

Sandulache

Vandelaar²,

Skinner

et al. 2016

Head & Neck

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Background We evaluated clinical and functional outcomes following salvage total laryngectomy (STL). Methods Retrospective review of 218 patients who underwent STL between 1994 and 2014. Results Seventy percent of patients originally had T1–2, N0 tumors and 73% had definitive external beam radiation therapy (EBRT) alone. A majority utilized TEP (77%) and were gastrostomy free (80%) at last follow up. The 5-year disease control and overall survival rates were 65% and 57%. Patients with disease-free interval (DFI) following initial treatment < 2 years were more likely to develop recurrence (p=0.001) and die of disease (p=0.032) following STL. DFI following EBRT impacted disease control (p<0.001), with 5-year disease control of 92% for >5 year DFI and 60% for <2 year DFI. Conclusion Most patients remain disease-free following STL, achieve intelligible tracheo-esophageal speech and maintain an oral diet. Delayed recurrence following initial treatment portends better survival and may indicate a distinct biological profile.

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Section: Discussionmentioning

confidence: 52%

Salvage total laryngectomy after external‐beam radiotherapy: A 20‐year experience

Sandulache

Vandelaar²,

Skinner

et al. 2016

Head & Neck

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“…We next compared our findings with other studies documenting occult nodal rates in salvage laryngectomy patients 7–18 . Overall, 11 studies were identified, with a total of 537 patients.…”

Section: Resultsmentioning

confidence: 95%

Occult Nodal Disease Prevalence and Distribution in Recurrent Laryngeal Cancer Requiring Salvage Laryngectomy

Birkeland

Rosko

Issa

et al. 2016

Otolaryngol.--head neck surg.

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Objectives The indications for neck dissection concurrent with salvage laryngectomy in the clinically N0 setting remain unclear. Our goals were to determine the prevalence of occult nodal disease, analyze nodal disease distribution patterns, and identify predictors of occult nodal disease in a salvage laryngectomy cohort. Study Design Case series with planned data collection. Setting Tertiary academic center. Subjects Patients with persistent or recurrent laryngeal squamous cell carcinoma after radiation/chemoradiation failure undergoing salvage laryngectomy with neck dissection. Methods We analyzed a single-institution retrospective case series of patients between 1997–2014 and identified those who had clinically N0 necks (n = 203). Clinical and pathologic data, including nodal prevalence and distribution were collected, and statistical analyses were performed. Results Overall, cN0 necks had histologically positive occult nodes in 17% (n=35) of cases. Univariate predictors of occult nodal positivity included recurrent T4 stage (34% T4 vs. 12% non-T4; p=0.0003), and supraglottic subsite (28% supraglottic vs. 10% non-supraglottic; p=0.0006). Histologically positive nodes associated with supraglottic primaries were most frequently positive in ipsilateral level II and III (17% and 16%). Positive nodes for glottic SCC were most frequently positive in the ipsilateral and contralateral paratracheal nodes (11% and 9%). Conclusion Histologically positive occult nodes are identified in 17% of cN0 patients undergoing salvage laryngectomy with neck dissection. Occult nodal disease varies in frequency and distribution based upon tumor subsite. Predictors of high (>20%) occult nodal positivity include T4 tumors and supraglottic subsite. In glottic SCCs, the most frequent sites of occult nodal disease are the paratracheal nodal basins.

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“…The laryngeal subsite of recurrence was documented in 6 studies (290/1141, 25.4% of patients) that contained patients who were cN0 and received END (164 glottic, 81 supraglottic, 43 transglottic, 2 subglottic). Unilateral and/or bilateral ND was noted in 7 studies . The treatment categories are summarized in Table .…”

Section: Resultsmentioning

confidence: 99%

“…A total of 17 studies met the inclusion criteria and were included in the quantitative metaanalysis. 4,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] The 45 excluded studies are summarized in Supporting Information Table S4 with reasons for exclusion.…”

Section: Literature Search Resultsmentioning

confidence: 99%

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

et al. 2019

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Background Approximately 30% of nonsurgically treated patients with laryngeal squamous cell carcinoma will suffer recurrence, and many will be clinically N0; the indication for elective neck dissection (END) remains uncertain. We aimed to determine whether END is indicated during salvage laryngectomy. Methods Systematic review and meta‐analysis. Results A total of 1141 patients were identified from 17 studies. Occult nodal positivity was 13.7% (106/775) confidence interval (CI) 11.3%‐16.1%; higher in supraglottic than glottic disease (17.8%, CI 10.3%‐25.3% vs 12%, CI 7.1%‐16.9%, P = .18). No significant difference existed between END vs observation in 5‐year disease free survival (odds ratio [OR] = 0.76, CI = 0.49‐1.17, P = .21, I2 = 10%) and overall survival (OS; OR = 0.96, CI = 0.65‐1.41, P = .82, I2 = 54%). Conclusions No significant survival advantage was found for END vs observation. Individual studies trended towards improved survival with END in supraglottic and locally advanced tumors. These factors should be considered when deciding on END in salvage laryngectomy.

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Should elective neck dissection be routinely performed in patients undergoing salvage total laryngectomy?

Cited by 31 publications

References 39 publications

Salvage total laryngectomy after external‐beam radiotherapy: A 20‐year experience

Salvage total laryngectomy after external‐beam radiotherapy: A 20‐year experience

Occult Nodal Disease Prevalence and Distribution in Recurrent Laryngeal Cancer Requiring Salvage Laryngectomy

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

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