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Should elective neck dissection be routinely performed in patients undergoing salvage total laryngectomy?

  • T F Pezier (a1), I J Nixon (a1), W Scotton (a1), A Joshi (a1), T Guerrero-Urbano (a1), R Oakley (a1), J-P Jeannon (a1) and R Simo (a1)...

Abstract

Background:

The prevalence of occult neck metastasis in patients undergoing salvage total laryngectomy remains unclear, and there is controversy regarding whether elective neck dissection should routinely be performed.

Method:

A retrospective case note review of 32 consecutive patients undergoing salvage total laryngectomy in a tertiary centre was performed, in order to correlate pre-operative radiological staging with histopathological staging.

Results:

The median patient age was 61 years (range, 43–84 years). With regard to lymph node metastasis, 28 patients were pre-operatively clinically staged (following primary radiotherapy or chemoradiotherapy) as node-negative, 1 patient was staged as N1, two patients as N2c and one patient as N3. Fifty-two elective and seven therapeutic neck dissections were performed. Pathological analysis up-staged two patients from clinically node-negative (following primary radiotherapy or chemoradiotherapy) to pathologically node-positive (post-surgery). No clinically node-positive patients were down-staged. More than half of the patients suffered a post-operative fistula.

Conclusion:

Pre-operative neck staging had a negative predictive value of 96 per cent. Given the increased complications associated with neck dissection in the salvage setting, consideration should be given to conservative management of the neck in clinically node-negative patients (staged following primary radiotherapy or chemoradiotherapy).

Copyright

Corresponding author

Address for correspondence: Mr T Pezier, ORL-Klinik, University Hospital Zurich, 8008 Zurich, Switzerland E-mail: tfrpezier@gmail.com

Footnotes

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Presented orally at the European Congress on Head and Neck Oncology Meeting, 18–21 April 2012, Poznan, Poland and at the British Association of Head and Neck Oncologists Meeting, 26–27 April 2012, London, UK, and presented as a poster at the American Head and Neck Societies Meeting, 21–25 July 2012, Toronto, Canada.

Footnotes

References

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1Forastiere, AA, Goepfert, H, Maor, M, Pajak, TF, Weber, R, Morrison, W et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 2003;349:2091–8
2Bohannon, IA, Desmond, RA, Clemons, L, Magnuson, JS, Carroll, WR, Rosenthal, EL. Management of the N0 neck in recurrent laryngeal squamous cell carcinoma. Laryngoscope 2010;120:5861
3Weber, RS, Berkey, BA, Forastiere, A, Cooper, J, Maor, M, Goepfert, H et al. Outcome of salvage total laryngectomy following organ preservation therapy: the Radiation Therapy Oncology Group trial 91-11. Arch Otolaryngol Head Neck Surg 2003;129:44–9
4Farrag, TY, Lin, FR, Cummings, CW, Koch, WM, Flint, PW, Califano, JA et al. Neck management in patients undergoing postradiotherapy salvage laryngeal surgery for recurrent/persistent laryngeal cancer. Laryngoscope 2006;116:1864–6
5Wax, MK, Touma, BJ. Management of the N0 neck during salvage laryngectomy. Laryngoscope 1999;109:47
6Scotton, W, Cobb, R, Pang, L, Nixon, I, Joshi, A, Jeannon, JP et al. Post-operative wound infection in salvage laryngectomy: does antibiotic prophylaxis have an impact? Eur Arch Otorhinolaryngol 2012;269:2415–22
7Hoffman, HT, Porter, K, Karnell, LH, Cooper, JS, Weber, RS, Langer, CJ et al. Laryngeal cancer in the United States: changes in demographics, patterns of care, and survival. Laryngoscope 2006;116:113
8Olsen, KD. Reexamining the treatment of advanced laryngeal cancer. Head Neck 2010;32:17
9Wolf, GT. Reexamining the treatment of advanced laryngeal cancer: the VA laryngeal cancer study revisited. Head Neck 2010;32:714
10Forastiere, AA. Larynx preservation and survival trends: should there be concern? Head Neck 2010;32:1417
11Ganly, I, Patel, SG, Matsuo, J, Singh, B, Kraus, DH, Boyle, J et al. Predictors of outcome for advanced-stage supraglottic laryngeal cancer. Head Neck 2009;31:1489–95
12Tabet, JC, Johnson, JT. Wound infection in head and neck surgery: prophylaxis, etiology and management. J Otolaryngol 1990;19:197200
13Penel, N, Lefebvre, D, Fournier, C, Sarini, J, Kara, A, Lefebvre, JL. Risk factors for wound infection in head and neck cancer surgery: a prospective study. Head Neck 2001;23:447–55
14Velanovich, V. A meta-analysis of prophylactic antibiotics in head and neck surgery. Plast Reconstr Surg 1991;87:429–34
15Sassler, AM, Esclamado, RM, Wolf, GT. Surgery after organ preservation therapy. Analysis of wound complications. Arch Otolaryngol Head Neck Surg 1995;121:162–5
16Wakisaka, N, Murono, S, Kondo, S, Furukawa, M, Yoshizaki, T. Post-operative pharyngocutaneous fistula after laryngectomy. Auris Nasus Larynx 2008;35:203–8
17Ogihara, H, Takeuchi, K, Majima, Y. Risk factors of postoperative infection in head and neck surgery. Auris Nasus Larynx 2009;36:457–60
18Penel, N, Fournier, C, Lefebvre, D, Lefebvre, JL. Multivariate analysis of risk factors for wound infection in head and neck squamous cell carcinoma surgery with opening of mucosa. Study of 260 surgical procedures. Oral Oncol 2005;41:294303
19Morgan, JE, Breau, RL, Suen, JY, Hanna, EY. Surgical wound complications after intensive chemoradiotherapy for advanced squamous cell carcinoma of the head and neck. Arch Otolaryngol Head Neck Surg 2007;133:1014
20Bieri, S, Bentzen, SM, Huguenin, P, Allal, AS, Cozzi, L, Landmann, C et al. Early morbidity after radiotherapy with or without chemotherapy in advanced head and neck cancer. Experience from four nonrandomized studies. Strahlenther Onkol 2003;179:390–5
21Lavertu, P, Bonafede, JP, Adelstein, DJ, Saxton, JP, Strome, M, Wanamaker, JR et al. Comparison of surgical complications after organ-preservation therapy in patients with stage III or IV squamous cell head and neck cancer. Arch Otolaryngol Head Neck Surg 1998;124:401–6
22Yao, M, Roebuck, JC, Holsinger, FC, Myers, JN. Elective neck dissection during salvage laryngectomy. Am J Otolaryngol 2005;26:388–92
23Gilbert, MR, Branstetter, BF 4th, Kim, S. Utility of positron-emission tomography/computed tomography imaging in the management of the neck in recurrent laryngeal cancer. Laryngoscope 2012;122:821–5
24Mendenhall, WM, Parsons, JT, Brant, TA, Stringer, SP, Cassisi, NJ, Million, RR. Is elective neck treatment indicated for T2N0 squamous cell carcinoma of the glottic larynx? Radiother Oncol 1989;14:199202
25Matsuo, JM, Patel, SG, Singh, B, Wong, RJ, Boyle, JO, Kraus, DH et al. Clinical nodal stage is an independently significant predictor of distant failure in patients with squamous cell carcinoma of the larynx. Ann Surg 2003;238:412–21
26Tankere, F, Camproux, A, Barry, B, Guedon, C, Depondt, J, Gehanno, P. Prognostic value of lymph node involvement in oral cancers: a study of 137 cases. Laryngoscope 2000;110:2061–5
27van den Brekel, MW, van der Waal, I, Meijer, CJ, Freeman, JL, Castelijns, JA, Snow, GB. The incidence of micrometastases in neck dissection specimens obtained from elective neck dissections. Laryngoscope 1996;106:987–91
28Alex, JC, Krag, DN. The gamma-probe-guided resection of radiolabeled primary lymph nodes. Surg Oncol Clin N Am 1996;5:3341
29Pitman, KT, Johnson, JT, Myers, EN. Effectiveness of selective neck dissection for management of the clinically negative neck. Arch Otolaryngol Head Neck Surg 1997;123:917–22
30Shah, JP. Patterns of cervical lymph node metastasis from squamous carcinomas of the upper aerodigestive tract. Am J Surg 1990;160:405–9
31Perie, S, Hugentobler, A, Susini, B, Balogova, S, Grahek, D, Kerrou, K et al. Impact of FDG-PET to detect recurrence of head and neck squamous cell carcinoma. Otolaryngol Head Neck Surg 2007;137:647–53
32Brouwer, J, Hooft, L, Hoekstra, OS, Riphagen, II, Castelijns, JA, de Bree, R et al. Systematic review: accuracy of imaging tests in the diagnosis of recurrent laryngeal carcinoma after radiotherapy. Head Neck 2008;30:889–97
33Pezier, T, Nixon, IJ, Gurney, B, Schilling, C, Hussain, K, Lyons, AJ et al. Sentinel lymph node biopsy for T1/T2 oral cavity squamous cell carcinoma–a prospective case series. Ann Surg Oncol 2012;19:3528–33
34de Hullu, JA, Piers, DA, Hollema, H, Aalders, JG, van der Zee, AG. Sentinel lymph node detection in locally recurrent carcinoma of the vulva. BJOG 2001;108:766–8
35Flach, GB, Broglie, MA, van Schie, A, Bloemena, E, Leemans, CR, de Bree, R et al. Sentinel node biopsy for oral and oropharyngeal squamous cell carcinoma in the previously treated neck. Oral Oncol 2012;48:85–9
36Thoeny, HC. Diffusion-weighted MRI in head and neck radiology: applications in oncology. Cancer Imaging 2011;10:209–14
37Tshering Vogel, DW, Zbaeren, P, Geretschlaeger, A, Vermathen, P, De Keyzer, F, Thoeny, HC. Diffusion-weighted MR imaging including bi-exponential fitting for the detection of recurrent or residual tumour after (chemo)radiotherapy for laryngeal and hypopharyngeal cancers. Eur Radiol 2012;23:562–9
38van den Brekel, MW, Stel, HV, van der Valk, P, van der Waal, I, Meyer, CJ, Snow, GB. Micrometastases from squamous cell carcinoma in neck dissection specimens. Eur Arch Otorhinolaryngol 1992;249:349–53
39Temam, S, Koka, V, Mamelle, G, Julieron, M, Carmantrant, R, Marandas, P et al. Treatment of the N0 neck during salvage surgery after radiotherapy of head and neck squamous cell carcinoma. Head Neck 2005;27:653–8

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