Is there a role for elective neck dissection with salvage laryngectomy? A decision‐analysis model

Hilly, Ohad; Stern, Sagit; Horowitz, Einav; Leshno, Moshe; Feinmesser, Raphael

doi:10.1002/lary.24138

Cited by 18 publications

(10 citation statements)

References 21 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, [20][21][22] others have demonstrated no benefit. 23,24 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: 99%

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: 99%

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

Sandulache

Vandelaar²,

Skinner

et al. 2016

Head & Neck

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“…Recently, the value of elective neck dissection during salvage laryngectomy was examined using a decision‐analysis model . Based on the limited data in the subject, neck dissection was not recommended as obligatory in every salvage laryngectomy.…”

Section: Discussionmentioning

confidence: 99%

Elective neck dissection during salvage total laryngectomy – a beneficial prognostic effect in locally advanced recurrent tumours

Hilly

Gil

Goldhaber

et al. 2015

Clinical Otolaryngology

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“…Our finding of a 6 per cent rate of occult nodal disease is consistent with contemporaneous studies analysing the same head and neck subsites as the present investigation, the vast majority of which report a rate between 5 and 20 per cent. 3,10,11,13–16 One study reported a higher rate of 28.3 per cent, but suggested that this may be a result of ‘differences in pathological assessment, or the presence of non-viable tumour cells’. 9…”

Section: Discussionmentioning

confidence: 99%

“…One recent study 16 has questioned the sensitivity of occult nodal disease rate as a decision-making tool, and suggested replacing it with risk of regional recurrence when designing decision algorithms for salvage surgery. This was based on lower rates of regional-only recurrence (0–8 per cent) compared with occult metastases (3–18 per cent) in the contemporaneous literature that they considered.…”

Section: Discussionmentioning

confidence: 99%

“…The relative scarcity of salvage head and neck surgery cases is a common theme amongst the literature, with the number of study participants analysed in recent studies consistently falling below 100, despite these studies each spanning multiple decades. 3,9,13–16 Meta-analysis of these results is made difficult by wide variations in study aims, scope and protocols.

Salvage laryngectomy presents a final opportunity to treat persistent disease or local recurrence in patients who have undergone radiotherapy for laryngeal squamous cell carcinomaNeck dissection of a previously irradiated neck carries an increased risk of complicationsHowever, neck dissection may uncover occult disease in some clinically diagnosed node-negative patients, benefitting survivalOur study revealed a 6 per cent risk of occult disease, smaller than in many previous studiesNeck dissection patients did not have a higher fistula rate, but did have longer hospitalisations and a higher return to theatre rateThe true three-year survival benefit of neck dissection remains unclear…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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ObjectivesThis study aimed to evaluate the effect of neck dissection on survival and complication rates in patients with no clinical or radiological evidence of cervical nodal disease (N0) undergoing salvage laryngectomy.MethodsA retrospective study was conducted of patients with squamous cell carcinoma of the larynx following primary radiotherapy that required salvage laryngectomy. Disease-free and overall survival rates were compared over three years using Kaplan–Meier analysis. Pharyngocutaneous fistula rate, hospitalisation length and the requirement for further surgical intervention were also compared across cohorts.ResultsTwenty-three cases met the inclusion criteria (17 neck dissections, 6 undissected). No significant differences in survival outcomes were identified. One patient who underwent neck dissection for advanced, recurrent transglottic squamous cell carcinoma showed evidence of occult lymph node metastases. Fistula rates did not differ significantly between dissected and non-dissected groups; however, two patients required surgical repair of post-operative pharyngocutaneous fistula following neck dissection.ConclusionIn this study, elective neck dissection did not appear to alter survival outcomes or complication rates during salvage laryngectomy. Given the small but significant risk of occult neck metastases, its true value remains unclear.

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Is there a role for elective neck dissection with salvage laryngectomy? A decision‐analysis model

Abstract: Based on our decision-analysis model, we do not recommend routine elective neck dissection during salvage total laryngectomy after failure of chemoradiation.

Cited by 18 publications

References 21 publications

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

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

Elective neck dissection during salvage total laryngectomy – a beneficial prognostic effect in locally advanced recurrent tumours

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

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