Premium
Meta‐analysis of risk of occult lymph node metastasis in the irradiated, clinically N0 neck
Author(s) -
Finegersh Andrey,
Moss William J.,
SaddawiKonefka Robert,
Faraji Farhoud,
Coffey Charles S.,
Califano Joseph A.,
Brumund Kevin T.,
Orosco Ryan K.
Publication year - 2020
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.26248
Subject(s) - medicine , occult , neck dissection , metastasis , radiation therapy , head and neck squamous cell carcinoma , salvage therapy , lymph node metastasis , oncology , surgery , lymph node , radiology , primary tumor , head and neck cancer , carcinoma , cancer , chemotherapy , pathology , alternative medicine
Background Recurrent head and neck squamous cell carcinoma (HNSCC) after radiation is associated with poor survival, and management of the clinically negative (N0) neck during salvage surgery is controversial. Methods Studies were selected according to preferred reporting items for systematic reviews and meta‐analyses guidelines. Inclusion criteria were patients with HNSCC, prior radiation to the lateral neck nodal basin, undergoing salvage surgery for local recurrence, persistence or second primary, and N0 at time of salvage. Eleven studies with a total of 382 patients met inclusion criteria. Results The rate of occult metastasis was 15.4%. The pooled rate of occult nodal metastasis was 16.2% for oral cavity, 12.9% for oropharynx, 23.7% for hypopharynx, and 27.3% for supraglottic or transglottic tumors. There was a significantly higher relative risk of occult metastasis for locally advanced tumors. Conclusion Elective neck dissection at time of salvage surgery should be considered based on subsite, T classification, and prior history of nodal metastasis.