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Management of the N0 neck in recurrent laryngeal squamous cell carcinoma
Author(s) -
Bohan Isaac A.,
Desmond Renee A.,
Clemons Lisa,
Magnuson J. Scott,
Carroll William R.,
Rosenthal Eben L.
Publication year - 2010
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.20675
Subject(s) - medicine , neck dissection , surgery , laryngectomy , retrospective cohort study , fistula , larynx , dissection (medical) , carcinoma
Objectives/Hypothesis: To evaluate the utility of neck dissections in patients undergoing salvage laryngectomy with a clinically negative neck. Study Design: Retrospective cohort study. Methods: This retrospective review identified 71 patients with N0 necks who underwent salvage laryngectomy from 2001 to 2007. The standard practice of surgeons within our institution was different, thus neck dissections were performed on approximately one half of the patients, creating two groups for comparison. The number of neck dissections with positive metastasis were examined. Postoperative complications, overall survival, and site of recurrence were compared between patients with neck dissection and no neck dissection. Results: Thirty‐eight patients underwent 71 neck dissections concurrently with salvage laryngectomy. A total of 33 patients had salvage laryngectomy without neck dissection. Only three of 71 neck dissections (4%) had positive nodal metastasis. The rate of fistula, wound infection, hematoma/bleeding, chyle leak, wound dehiscence, and flap failure did not reveal any statistical differences. However, the overall complication rate in neck dissections patients was higher (42.2 %) than no neck dissections (21.3%; P = .04). Neck dissection patients had a higher proportion of fistulas (32%) than no dissections (18%; P = .2). Regional failure occurred in 7.9% of the patients with neck dissections and 15% of patients without neck dissection ( P = .5). There was no survival advantage for patients who underwent neck dissection compared to no neck dissection ( P = .47). Conclusions: There was no survival advantage gained by performing neck dissection in the clinically negative neck. However, a trend toward reduced regional failure with neck dissection must be balanced by the increased potential for complications and fistulae. Laryngoscope, 2010