A Risk-Adapted Approach for Elective Neck Dissection in Salvage Total Laryngectomy: Revisiting the Role of Tumor Subsite and Occult Nodal Disease

Carlos M Chiesa-Estomba; Antoine Melkane; Didier Dequanter; Aina Brunet; Antonino Maniaci; Khawla Karra; Jerome R Lechien; Paulina Droppelman-Alvarez; Amaya Roldan-Fidalgo; Jose Palacios; Eva Baguda; Tareck Ayad

doi:10.1002/hed.70072

A Risk-Adapted Approach for Elective Neck Dissection in Salvage Total Laryngectomy: Revisiting the Role of Tumor Subsite and Occult Nodal Disease

Head Neck. 2026 Mar;48(3):722-732. doi: 10.1002/hed.70072. Epub 2025 Oct 13.

Authors

Carlos M Chiesa-Estomba^{1

2

3}, Antoine Melkane^{3

4}, Didier Dequanter^{3

5}, Aina Brunet⁶, Antonino Maniaci^{3

7}, Khawla Karra⁸, Jerome R Lechien^{3

5

9}, Paulina Droppelman-Alvarez^{1

2}, Amaya Roldan-Fidalgo¹⁰, Jose Palacios¹¹, Eva Baguda⁶, Tareck Ayad^{3

8}

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Donostia University Hospital, San Sebastián, Spain.
² Faculty of Medicine, Deusto University, Bilbao, Spain.
³ Head & Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies YO-IFOS, Paris, France.
⁴ Department of Otolaryngology-Head and Neck Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon.
⁵ Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium.
⁶ Department of Otolaryngology-Head and Neck Surgery, Hospital Universitari Bellvitge, Barcelona, España.
⁷ Department of Medicine and Surgery, University Enna Kore, Enna, Italy.
⁸ Department of Otolaryngology-Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Canada.
⁹ Department of Surgery, University of Mons, Mons, Belgium.
¹⁰ Department of Otolaryngology-Head and Neck Surgery, Hospital Universitario Son Llatzer, Palma de Mallorca, España.
¹¹ Department of Otolaryngology, Head and Neck Surgery, Virgen Macarena University Hospital, Seville, Spain.

PMID: 41078315
DOI: 10.1002/hed.70072

Abstract

Background: The role of elective neck dissection (END) during salvage total laryngectomy (STL) in clinically node-negative (cN0) patients remains controversial due to variable risks of occult nodal metastasis and surgical morbidity.

Methods: We conducted a multicenter retrospective study of 178 cN0 patients undergoing STL after radiotherapy (RT) or chemoradiotherapy (CRT). Rates of occult nodal disease, survival outcomes, and predictive factors were analyzed.

Results: Occult nodal metastases were found in 19.7% of cases, highest in hypopharyngeal (35.7%) and supraglottic (24.5%) tumors. Tumor subsite and lymphovascular invasion were independent predictors of nodal positivity, while prior chemotherapy reduced risk. Patients with occult nodal disease had significantly worse three-year overall and disease-specific survival.

Conclusions: A risk-adapted approach to END in STL is recommended, particularly for supraglottic and hypopharyngeal tumors. Routine END may be unnecessary in low-risk subsites like glottic tumors. Prospective studies are needed to refine management strategies.

Keywords: elective neck dissection; head and neck cancer; hypopharynx; occult nodal metastasis; salvage total laryngectomy; supraglottis.

Publication types

Multicenter Study

MeSH terms

Adult
Aged
Aged, 80 and over
Carcinoma, Squamous Cell* / mortality
Carcinoma, Squamous Cell* / pathology
Carcinoma, Squamous Cell* / surgery
Carcinoma, Squamous Cell* / therapy
Disease-Free Survival
Elective Surgical Procedures / methods
Female
Humans
Laryngeal Neoplasms* / mortality
Laryngeal Neoplasms* / pathology
Laryngeal Neoplasms* / surgery
Laryngeal Neoplasms* / therapy
Laryngectomy* / methods
Lymphatic Metastasis
Male
Middle Aged
Neck Dissection* / methods
Neoplasm Staging
Retrospective Studies
Risk Assessment
Salvage Therapy* / methods
Survival Analysis