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Elective neck dissection for the node-negative neck during salvage laryngectomy: an analysis of survival outcomes and complication rates

Published online by Cambridge University Press:  22 August 2019

M Gouzos ,
O Dale ,
N Sethi ,
A Foreman ,
S Krishnan  and
JC Hodge
M Gouzos
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Royal Adelaide Hospital, Australia
O Dale
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Royal Adelaide Hospital, Australia
N Sethi
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Royal Adelaide Hospital, Australia
A Foreman
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Royal Adelaide Hospital, Australia
S Krishnan
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Royal Adelaide Hospital, Australia
JC Hodge*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Royal Adelaide Hospital, Australia
*
Author for correspondence: Dr J C Hodge, Department of Otolaryngology – Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, SA 5000, Australia E-mail: jchodge27@hotmail.com
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Abstract

Objectives

This study aimed to evaluate the effect of neck dissection on survival and complication rates in patients with no clinical or radiological evidence of cervical nodal disease (N0) undergoing salvage laryngectomy.

Methods

A retrospective study was conducted of patients with squamous cell carcinoma of the larynx following primary radiotherapy that required salvage laryngectomy. Disease-free and overall survival rates were compared over three years using Kaplan–Meier analysis. Pharyngocutaneous fistula rate, hospitalisation length and the requirement for further surgical intervention were also compared across cohorts.

Results

Twenty-three cases met the inclusion criteria (17 neck dissections, 6 undissected). No significant differences in survival outcomes were identified. One patient who underwent neck dissection for advanced, recurrent transglottic squamous cell carcinoma showed evidence of occult lymph node metastases. Fistula rates did not differ significantly between dissected and non-dissected groups; however, two patients required surgical repair of post-operative pharyngocutaneous fistula following neck dissection.

Conclusion

In this study, elective neck dissection did not appear to alter survival outcomes or complication rates during salvage laryngectomy. Given the small but significant risk of occult neck metastases, its true value remains unclear.

Keywords

Salvage TherapyLaryngectomyNeck DissectionSurgical Oncology
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 133 , Issue 9 , September 2019 , pp. 788 - 791
Copyright
Copyright © JLO (1984) Limited, 2019 

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Footnotes

Dr J C Hodge takes responsibility for the integrity of the content of the paper

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