Review of oncological findings and complications after elective neck dissection during total laryngectomy: a case series
Abstract Background This study aims to report the rate of occult lymph node metastasis during elective neck dissection in clinically and radiologically negative neck (cN0) for patients offered total laryngectomy as either primary or salvage treatment. We also compare the rate of complications and re...
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| Autores principales: | , , , , , |
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| Formato: | article |
| Lenguaje: | EN |
| Publicado: |
SpringerOpen
2021
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| Materias: | |
| Acceso en línea: | https://doaj.org/article/2eaefd2b7b994c3cba10793eeac1ce70 |
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| Sumario: | Abstract Background This study aims to report the rate of occult lymph node metastasis during elective neck dissection in clinically and radiologically negative neck (cN0) for patients offered total laryngectomy as either primary or salvage treatment. We also compare the rate of complications and recurrence after elective neck dissection during total laryngectomy. A retrospective review of patients treated in a single teaching hospital in the UK between 2004 and 2020 was performed. We collected the following patient information: age, sex, TNM staging, tumour location and laterality, primary treatment received if recurrent, preoperative imaging, operative details of the elective neck dissection, pathology results, postoperative complications, and recurrence. Inclusion criteria are as follows: squamous cell carcinoma and cN0 neck. Exclusion criteria are as follows: second primary tumour in the head and neck, a total laryngectomy because of a dysfunctional larynx, or a previously performed neck dissection. Results Of the 105 included patients, 66 (63%) had primary surgery and 39 (37%) were offered salvage surgery. All cases in the primary group were offered elective neck dissection. Thirty-six patients of the salvage group were offered elective neck dissection. The rate of occult lymph node metastasis was 35% (23/66) and 5.6% (2/36) in the primary and salvage groups, respectively. There was no difference in the overall complication rate in both groups, although the specific incidence of pharyngocutaneous fistula in the salvage group was higher compared with the primary group, 14% vs 7.5%. Conclusions We conclude that elective neck dissection is indicated during primary total laryngectomy due to the high rate of occult lymph node metastasis, 35% (23/66) in our series. Conversely, from our data in the salvage setting, the rate of occult lymph node was very low at 5.6% (2/36). The impact on survival is not known. The decision over elective neck dissection may be made more judiciously on an individual basis in the salvage setting. |
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