Surgical and pathological outcomes of elective neck dissection during salvage total laryngectomy

Asimakopoulos, Panagiotis; Thompson, Christopher Sg; Hogg, Gordon E.; Evans, Andrew; Adamson, Richard; Vernham, Guy A.; Nixon, Iain J.

doi:10.1111/coa.13266

Cited by 7 publications

(13 citation statements)

References 9 publications

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“…After the comprehensive search and application of appropriate exclusion and inclusion criteria, 18 studies were included for systematic review, with a total of 1,141 patients (799 END, 350 observed) . All but one study (Wax and Touma) were retrospective.…”

Section: Resultsmentioning

confidence: 99%

“…A small number of largely retrospective studies have explored this question and report rates of occult nodal disease in recurrent laryngeal cancer as ranging from 0% to 27%. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] The decision to perform an elective neck dissection (END) during salvage surgery remains unclear due to conflicting evidence of its impact on survival. 13,14,24,25 There are also reports of increased postoperative complication and fistula rates after salvage neck dissection.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

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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“…Amit et al described standardized paratracheal NDs bilaterally and unilateral or bilateral dissection of levels II‐IV, depending on the stage and subsite of the tumor. They performed 42 ipsilateral NDs and 9 bilateral NDs and found no occult nodal metastases in the contralateral neck, similarly no contralateral neck disease was found in a recently published cohort . A total of 3 studies reported occult nodal metastases in hemidissected necks (unilateral and bilateral NDs), however, did not comment on whether they occurred in the contralateral neck.…”

Section: Discussionmentioning

confidence: 85%

“…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%

“…They performed 42 ipsilateral NDs and 9 bilateral NDs and found no occult nodal metastases in the contralateral neck, similarly no contralateral neck disease was found in a recently published cohort. 18 A total of 3 studies 20 inspected intraoperatively; any suspicious lymph nodes were removed by selective upper node dissection, and if either inspection or dissection was positive for neck metastases a modified radical ND of levels I-V was performed on the affected side. 13 Using this method of intraoperative nodal inspection, the reported occult nodal positivity rate from this cohort (12.5%) was similar to the pooled result from our review, and the occult node occurred in the contralateral neck in only 1 of the 4 patients.…”

Section: Comparison Of Elective Unilateral Bilateral and Central Ndmentioning

confidence: 99%

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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

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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Oncologic Outcomes After Clinically Node-Negative Salvage Laryngectomy

Gross

Patel

Switchenko

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceControversy exists regarding management of the clinically node-negative neck in patients with recurrent larynx or hypopharynx cancers who received total laryngectomy after definitive radiation with or without chemotherapy.ObjectiveTo explore clinical and oncologic outcomes after elective neck dissection vs observation in patients who received clinically node-negative salvage total laryngectomy.Design, Setting, and ParticipantsThis cohort study was performed from January 2009 to June 2021 at a single, high-volume tertiary care center. Follow-up was conducted through June 2021 for all patients. Survival outcomes were based on at least 2 years of follow-up. Patients aged 18 years or older with recurrent, clinically node-negative larynx or hypopharynx tumors after definitive nonsurgical treatment who were treated with a salvage total laryngectomy were included. Data were analyzed from October 2021 through September 2022.ExposuresElective neck dissection.Main Outcomes and MeasuresPresence and location of occult nodal metastasis in electively dissected necks, along with differences in fistula rates and overall and disease-free survival between patients receiving elective neck dissection vs observation.ResultsAmong 107 patients receiving clinically node-negative salvage total laryngectomy (median [IQR] age, 65.0 [57.8-71.3] years; 91 [85.0%] men), 81 patients underwent elective neck dissection (75.7%) and 26 patients underwent observation (24.3%). Among patients with elective neck dissection, 13 patients had occult nodal positivity (16.0%). Recurrent supraglottic (4 of 20 patients [20.0%]) or advanced T classification (ie, T3-T4; 12 of 61 patients [19.7%]) had an occult nodal positivity rate of 20% or more, and positive nodes were most likely to occur in levels II and III (II: 6 of 67 patients [9.0%]; III: 6 of 65 patients [9.2%]; VI: 3 of 44 patients [6.8%]; IV: 3 of 62 patients [4.8%]; V: 0 of 4 patients; I: 0 of 18 patients). There was a large difference in fistula rate between elective neck dissection (12 patients [14.8%]) and observed (8 patients [30.8%]) groups (difference, 16.0 percentage points; 95% CI, −3.4 to 35.3 percentage points), while the difference in fistula rate was negligible between 50 patients undergoing regional or free flap reconstruction (10 patients [20.0%]) vs 57 patients undergoing primary closure (10 patients [17.5%]) (difference, 2.5 percentage points; 95% CI, −12.4 to 17.3 percentage points). Undergoing elective neck dissection was not associated with a clinically meaningful improvement in overall or disease-free survival compared with observation. Recurrent hypopharynx subsite was associated with an increased risk of death (hazard ratio, 4.28; 95% CI, 1.81 to 10.09) and distant recurrence (hazard ratio, 7.94; 95% CI, 2.07 to 30.48) compared with glottic subsite.Conclusions and RelevanceIn this cohort study, patients with recurrent supraglottic or advanced T classification tumors had an increased occult nodal positivity rate, elective neck dissection was not associated with survival, and patients with recurrent hypopharynx subsite were more likely to have a distant recurrence and die of their disease. These findings suggest that underlying disease pathology rather than surgical management may be associated with survival outcomes in this population.

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Surgical and pathological outcomes of elective neck dissection during salvage total laryngectomy

Cited by 7 publications

References 9 publications

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

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

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

Oncologic Outcomes After Clinically Node-Negative Salvage Laryngectomy

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