Surgical nodal management in hypopharyngeal and laryngeal cancer

Abstract

Objective The aim of this study is to compare pre-therapeutic staging of the loco-regional lymphatic basin and subsequent surgical management in cN0 versus cN+ hypopharyngeal and laryngeal cancer patients. Methods We analyzed all hypopharyngeal and laryngeal carcinoma patients treated surgically at a single quaternary medical care and cancer center between 2004 and 2014. We established two groups for patients who underwent neck dissection comparing patients with a low LNR (lymph node ratio) to one with a high LNR. Regarding the cN0 cohort, elective neck dissection was evaluated as a secondary predictor variable. Comorbidities, such as anemia and renal insufficiency, were analyzed as potentially influencing disease-free (DFS) and overall survival (OS). Results A total of 310 patients (185 glottic and 125 supraglottic/hypopharyngeal carcinoma) were included. Pre-therapeutic neck MRI-/CT-scan and concomitant neck ultrasound revealed cN+ status in 144 patients resulting in a significant overstaging in 63 patients (44%) who were rated as being pN0 after histological examination. 166 patients were staged cN0 and 21 underwent elective neck dissection (11 local advanced glottic and 10 supraglottic/hypopharyngeal carcinoma). Two cN0 patients showed occult cervical lymph node metastases (10%). Furthermore, we could detect a significant negative impact of the LNR divided by the number of dissected lymph nodes and OS. Conclusion The pre-therapeutic clinical evaluation of lymphatic outgrowth is over-staged. OS decreases with increasing LNR divided by the number of dissected lymph nodes. Renal insufficiency and anemia are significant negative factors, decreasing both OS and DFS. KeywordsHypopharyngeal carcinoma · Laryngeal carcinoma · Overall survival · cN0 · Elective neck dissection · Head and neck cancer Abbreviations CT Computed tomography DFS Disease-free survival DM Distant metastasis HNSCC Head and neck squamous cell carcinoma LNR Lymph node ratio MRI

Development and validation of a diagnostic model for predicting cervical lymph node metastasis in laryngeal and hypopharyngeal carcinoma

“…This case underscores the strengths of our model in predicting neck lymph node status, thereby aiding clinical decision-making. The study indicates that current clinical assessment methods are no longer sufficient to accommodate the complex needs of patients ( 12 , 13 ). In contrast, our model has the potential to prevent both over-treatment and under-treatment resulting from limited assessments.…”

Rational surgical neck management in total laryngectomy for advanced stage laryngeal squamous cell carcinomas

“…This fact should not be underestimated and survival outcome should not be jeopardized when considering surgical refinement in terms of reducing the extent of dissection. In contrast, several previous retrospective studies showed no significant influence of elective neck dissection (END) on survival in advanced laryngeal cancers (Ketterer et al 2020;Shi et al 2019;Kennedy et al 2017;Djordjevic et al 2016;Canis et al 2012). For salvage TL cases, END is not generally recommended, because, although it reduces the rate of regional recurrence, it does not provide a survival benefit as stated in a recent meta-analysis (Davies-Husband et al 2020).…”

The role of adjuvant therapy in pT4N0 laryngectomized patients: Multicentric observational study

“…Lymph nodes metastasis has widely been described as one of the main prognostic factors of laryngeal cancer and is associated with an increased risk of regional recurrence. 25 , 26 , 27 , 28 Different studies have investigated the importance of ND including an adequate number of lymph nodes in improving regional control and survival rates, however no consensus exists on superiority of bilateral versus unilateral ND for glottic LALC yet. 25 , 29 , 30 …”