Occult neck metastasis in salvage laryngectomy: a road map for super-selective neck dissection

J Laryngol Otol. 2024 Sep;138(9):979-982. doi: 10.1017/S0022215124000720. Epub 2024 Apr 24.

Abstract

Objective: This study aimed to solve the debate over the role and extent of neck dissection to treat any occult nodal metastasis in patients undergoing salvage laryngectomy for recurrent and/or residual squamous cell carcinoma of larynx.

Methods: This was a retrospective study over a time frame of 6 years (2016-2022) of 74 patients who underwent bilateral neck dissection and salvage laryngectomy for recurrent or persistent disease with N0 neck. We calculated the incidence of occult nodal metastasis in ipsilateral and contralateral neck.

Results: Incidence of ipsilateral neck disease was calculated as 8.11 per cent and it was 0 per cent in contralateral neck. Regarding ipsilateral nodal level distribution, level II was the highest at 6.76 per cent, followed by level III at 5.41 per cent. There was 0 per cent metastasis in levels IV and IIb.

Conclusion: In patients undergoing salvage laryngectomy with N0 neck, ipsilateral super selective neck dissection is considered a convenient and oncologically safe option to treat the neck.

Keywords: health planning guidelines; neoplasms.

MeSH terms

  • Adult
  • Aged
  • Carcinoma, Squamous Cell* / pathology
  • Carcinoma, Squamous Cell* / secondary
  • Carcinoma, Squamous Cell* / surgery
  • Female
  • Humans
  • Laryngeal Neoplasms* / pathology
  • Laryngeal Neoplasms* / surgery
  • Laryngectomy* / methods
  • Lymphatic Metastasis*
  • Male
  • Middle Aged
  • Neck Dissection* / methods
  • Neoplasm Recurrence, Local / epidemiology
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Recurrence, Local / surgery
  • Retrospective Studies
  • Salvage Therapy* / methods