Elective neck dissection during salvage laryngectomy

Yao, Mike; Roebuck, Jeremy C.; Holsinger, F. Christopher; Myers, Jeffery N.

doi:10.1016/j.amjoto.2005.05.002

Cited by 62 publications

(122 citation statements)

References 11 publications

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“…Several recent studies concluded that neck dissection is indicated for recurrent advanced stage laryngeal cancer. 7,22 However, these studies failed to demonstrate a survival advantage in patients who underwent neck dissection. Some authors have advocated bilateral neck dissection for all advanced stage (T 3 and T 4 ) glottic recurrences and for all supraglottic recurrences regardless of stage.…”

Section: Discussionmentioning

confidence: 99%

“…6,7,21 This is especially true for advanced laryngeal carcinomas after failure of chemoradiation protocols; however, there are few data for early glottic cancers that recur after RT. In fact, at the time of first diagnosis, these patients have a very low risk of occult neck disease.…”

Section: Discussionmentioning

confidence: 99%

“…Previous reports indicate an incidence of 10-28 per cent occult neck metastasis in persistent and recurrent laryngeal disease after primary RT. [6][7][8][9] Accurate restaging with scrupulous reassessment of the nodal status cannot completely rule out the presence of occult neck disease. [10][11][12] Small nodal metastases are still a diagnostic challenge despite continuing improvements in imaging techniques.…”

Section: Introductionmentioning

confidence: 99%

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Is elective neck dissection necessary in cases of laryngeal recurrence after previous radiotherapy for early glottic cancer?

et al. 2014

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Objectives: To assess the clinical utility of elective neck dissection in node-negative recurrent laryngeal carcinoma after curative radiotherapy for initial early glottic cancer.Methods: A retrospective review was undertaken of 110 consecutive early glottic cancer patients who developed laryngeal recurrence after radiotherapy (34 recurrent T 1 , 36 recurrent T 2 , 29 recurrent T 3 and 11 recurrent T 4a ) and received salvage laryngeal surgery between 1995 and 2005.Results: Six patients presented with laryngeal and neck recurrence and underwent salvage laryngectomy with therapeutic neck dissection, 97 patients with recurrent node-negative tumours underwent salvage laryngeal surgery without neck dissection and only 7 underwent elective neck dissection. No occult positive lymph nodes were documented in neck dissection specimens. During follow up, only three patients with neck failure were recorded, all in the group without neck dissection. There was no significant association between the irradiation field (larynx plus neck vs larynx) and the development of regional failure. A higher rate of post-operative pharyngocutaneous fistula development occurred in the neck dissection group than in the group without neck dissection (57.2 per cent vs 13.4 per cent, p = 0.01). Multivariate logistic regression analysis showed that early (recurrent tumour-positive, node-positive) or delayed (recurrent tumour-positive, node-negative) neck relapse was not significantly related to the stage of the initial tumour or the recurrent tumour. An age of less than 60 years was significantly associated with early neck failure (recurrent tumour-positive, node-positive).Conclusion: Owing to the low occult neck disease rate and high post-operative fistula rate, elective neck dissection is not recommended for recurrent node-negative laryngeal tumours after radiation therapy if the initial tumour was an early glottic cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Is elective neck dissection necessary in cases of laryngeal recurrence after previous radiotherapy for early glottic cancer?

et al. 2014

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“…Some authors advocate a wait and see policy for persistent lymph nodes in head an neck cancer as long as a decrease in size can be demonstrated after chemoradiotherapy [14]. Others are in favor of an immediate ND after RC-HT for all patient with initial N2-N3 [15] or only in N3 [16][17][18][19] neck disease even in presence of complete response. We believe that salvage ND for suspicion of residual disease is of low morbidity and should therefore be recommended in regard to individual tumor control.…”

Section: Discussionmentioning

confidence: 99%

Salvage surgery after failure of non surgical therapy for advanced head and neck cancer

Dequanter¹,

Vercruysse²,

Shahla³

et al. 2011

OJST

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Introduction: for organ and function preservation, chemoradiotherapy is gaining popularity for primary treatment of advanced head and neck cancer, reserveing surgery for salvage. Methods: Retrospective outcome analysis to determine the results of salvage surgery after failure of primary treatment of advanced head and neck cancer by chemoradiotherapy. 104 patients with advanced head and cancer were initially treated by chemoradiotherapy. Follow-up was evaluated in 27 patients undergoing salvage surgery for recurrent tumor (larynx n = 13; oral cavity n = 9; hypopharynx n = 5). The initial tumor is stage T3 in 11 cases and T4 in 16 cases. 10 patients had primary tumors stage III and 17 patients had tumors stage IV. Results: One postoperative death occured following surgery. The overall incidence of complications was 9/ 27 (%). Recurrent disease developed at the primary initially treated in 25 cases and in the neck in 2 cases after a mean follow-up of 11 months (3 -136 months). After salvage surgery, loco-regional recurrence and/ or distant disease developed in 10/27 patients after a mean follow-up of 4 months. 6/10 (60%) patients died after re-recurrence despite salvage chemotherapy. Conclusion: Salvage surgery after failure of initial chemoradiotherapy is burdened with high morbidity and bad oncological outcome. We demonstrated that it is difficult to salvage locally recurrent head and neck cancer especially at more advanced T-stages or when tumor recur. The limited effect of surgical salvage for recurrent tumor need to be addressed when choosing the initial treatment plan.

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“…There was no difference in 5-year overall survival between the neck dissected and observed groups. 31 Dagan et al did a retrospective review of 57 patients of locally recurrent head and neck squamous cell carcinoma who were initially treated with elective nodal irradiation (ENI). Forty patients underwent ND and 17 patients had neck observation only.…”

Section: Elective Nd In Locally Recurrent Setting In Initial N0 Neckmentioning

confidence: 99%

Salvage Neck Dissection after Chemoradiation in Head and Neck Cancer: Practice and Pitfalls

Agarwal¹,

Kundu²,

Krishnatry³

et al. 2012

International Journal of Head and Neck Surgery

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Locally advanced head and neck cancers are usually treated with concurrent chemoradiation. The residual nodes after chemoradiation in such patients are a common scenario, but the further investigation and treatment options in form of neck dissection are still not very clear. This review focuses on the current state of available evidence in literature for management of such patients and directs for the future development to fill the lacunae.

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Elective neck dissection during salvage laryngectomy

Cited by 62 publications

References 11 publications

Is elective neck dissection necessary in cases of laryngeal recurrence after previous radiotherapy for early glottic cancer?

Is elective neck dissection necessary in cases of laryngeal recurrence after previous radiotherapy for early glottic cancer?

Salvage surgery after failure of non surgical therapy for advanced head and neck cancer

Salvage Neck Dissection after Chemoradiation in Head and Neck Cancer: Practice and Pitfalls

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