Elective neck dissection for the node-negative neck during salvage laryngectomy: an analysis of survival outcomes and complication rates

Gouzos, Michael; Dale, Oliver; Sethi, Neeraj; Foreman, Andrew; Krishnan, Suren; Hodge, John-Charles

doi:10.1017/s0022215119001725

Cited by 7 publications

(7 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A 2020 meta-analysis showed a relative risk of disease-specific mortality of 1.04 (95% CI, 0.83-1.3) between END and observation. The decision to perform an END at the time of salvage TL may also be associated with morbidity secondary to increased postoperative complication and fistula rates . Additionally, if an END is performed, there is little guidance to support which nodal stations to dissect in an irradiated field, warranting further investigation …”

Section: Introductionmentioning

confidence: 99%

Oncologic Outcomes After Clinically Node-Negative Salvage Laryngectomy

Gross

Patel

Switchenko

et al. 2023

JAMA Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

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.

show abstract

Section: Introductionmentioning

confidence: 99%

Oncologic Outcomes After Clinically Node-Negative Salvage Laryngectomy

Gross

Patel

Switchenko

et al. 2023

JAMA Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

show abstract

“…Gouzos et al looked at the 3‐year outcomes for salvage laryngectomy patients with no clinical or radiological evidence of cervical nodal disease and found no significant difference in survival outcomes or post‐operative complications based on extent of nodal surgery 10 . This has been replicated in a meta‐analysis also showing no significant difference of overall survival at 5 years in patients in the salvage laryngectomy setting against patients whose necks were observed 3 .…”

Section: Discussionmentioning

confidence: 98%

“…Brazilian group (n = 272) who analysed the issue of contralateral neck disease in the salvage laryngectomy setting also found low rates of occult disease (3.5%), with a higher risk associated with supraglottic primary sites, mainly involving level II and level III nodes 9. Gouzos et al looked at the 3-year outcomes for salvage laryngectomy patients with no clinical or radiological evidence of cervical nodal disease and found no significant difference in survival outcomes or post-operative complications based on extent of nodal surgery 10. This has been replicated in a meta-analysis also showing no significant difference of overall survival at 5 years in patients Overall survival and disease-specific survival of salvage laryngectomy patients Nodal staging based on anatomical position of the tumour…”

mentioning

confidence: 98%

Is elective contralateral neck dissection necessary in 53 salvage total laryngectomy patients?

Hogg

Thompson

Asimakopoulos

et al. 2021

Clinical Otolaryngology

View full text Add to dashboard Cite

Historically, if the risk of occult nodal disease is >20%, elective neck dissection was advised for surgical management of squamous cell carcinoma (SCC). 1,2 A recent meta-analysis in the salvage laryngectomy setting (n = 1141) reported an occult nodal positivity rate (cN0pN+) of 11%, 3 which was higher in advanced local supraglottic (24%) or transglottic (17%) disease. Therefore, in high-risk patients undergoing salvage laryngectomy, neck dissection is generally recommended.The cN0pN+ disease rate in the contralateral neck in salvage total laryngectomy remains unclear and studies have shown neck dissection does not improve locoregional control or overall survivial. [4][5][6] The primary aim of this study is to report the rate of nodal metastases in the contralateral neck for patients undergoing salvage laryngectomy and to identify predictors of occult neck disease. | MATERIAL AND ME THODS | Ethical considerationsData were collected with Caldicott guardian approval (ref 16111). The South East Scotland Research Ethics committee waived the need for formal ethical approval due to the retrospective nature of data collection.

show abstract

“…7-10 Many authors have shown low yield of positive lymph nodes, higher complication rates, and ultimately no improvement in regional control or survival outcomes. 10-14 Still, some authors who have shown a higher rate of nodal metastasis or survival benefit advocate for neck dissection in the salvage setting either routinely or in selected cases. 10,15-17 These studies are based on single institution experiences and are limited by small patient numbers.…”

Section: Introductionmentioning

confidence: 99%

Neck Dissection in Salvage Surgery for Larynx Cancer: National Cancer Database Review

Patel

Toor

Tajudeen

et al. 2021

Ann Otol Rhinol Laryngol

View full text Add to dashboard Cite

Objective: Salvage laryngeal surgery is the preferred treatment after failure of non-surgical treatment of larynx cancer. This study aims to identify the impact of ND in salvage surgery on survival and factors predictive of nodal metastasis. Methods: The National Cancer Database was used to identify patients who received salvage laryngeal surgery. Demographics, disease characteristics, and survival were compared between the subgroups of patients stratified according to performance of ND and presence of nodal metastasis. Results: Sixty-two percent of patients underwent ND. A total of 26% of patients undergoing ND had nodal metastasis. Younger age and lesser time since radiation were associated with nodal metastasis. While undergoing ND did not significantly affect survival, those with nodal metastasis had poorer survival ( P = .001). Conclusions: Although ND did not show a survival benefit, younger patients and those who have had a shorter time elapsed between the start of radiation and salvage surgery may benefit from the prognostic data provided by ND. Nonetheless, the risks and benefits of elective ND in salvage larynx cancer treatment should be evaluated on an individual case basis as the data do not support a broadly applicable recommendation.

show abstract

Elective neck dissection for the node-negative neck during salvage laryngectomy: an analysis of survival outcomes and complication rates

Cited by 7 publications

References 20 publications

Oncologic Outcomes After Clinically Node-Negative Salvage Laryngectomy

Oncologic Outcomes After Clinically Node-Negative Salvage Laryngectomy

Is elective contralateral neck dissection necessary in 53 salvage total laryngectomy patients?

Neck Dissection in Salvage Surgery for Larynx Cancer: National Cancer Database Review

Contact Info

Product

Resources

About