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Neck dissection did not significantly affect regional control of larynx, hypopharynx cancers
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The incidence of cervical nodal metastatic disease is low in elective neck dissection specimens from patients who underwent salvage total laryngectomy and whose preoperative imaging results tested negative for nodal disease, according to results of a retrospective study.
Therefore, elective neck dissection did not appear to have any significant effect on postoperative regional cancer control, researchers concluded.
The study included 45 patients who underwent salvage total laryngectomy for squamous cell carcinoma of the larynx or hypopharynx between1996 and 2011. All patients failed initial radiotherapy or chemoradiotherapy.
Incidence of cervical nodal metastases identified by pathological examination of elective neck dissection specimens served as the primary outcome measure. Secondary outcome measures included regional cancer control and incidence of major postoperative complications.
Thirty-eight patients underwent elective neck dissection at the time of laryngectomy; of them, 20 underwent unilateral neck dissection and 18 underwent bilateral neck dissection.
Among those who underwent elective neck dissection, 8% had occult metastases. Patients who underwent bilateral neck dissection had an increased incidence of major wound complications compared with those who underwent unilateral or no neck dissection (67% vs. 30%; P=.03).
Researchers observed no significant differences in regional control according to whether bilateral, unilateral or no neck dissection was performed.
“In cases in which preoperative imaging results are suspicious for regional nodal disease or in which exposure of vessels in the neck is going to be required for simultaneous free flap reconstruction of the pharynx, neck dissection is clearly indicated,” researchers wrote. “However, our data would suggest that in cases of radiographically negative necks in patients not undergoing free flap reconstruction, the need for bilateral elective neck dissection should be weighed against this possible increased risk of morbidity.”
Disclosure: The researchers report no relevant financial disclosers.
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