Is routine neck dissection warranted at salvage laryngectomy?

2021 ◽  
pp. 1-6
Author(s):  
S Sharma ◽  
D A Chaukar ◽  
M Bal ◽  
A K D'Cruz
Keyword(s):  
Neck Dissection ◽  
Residual Disease ◽  
Multivariable Analysis ◽  
Nodal Metastasis ◽  
Elective Neck Dissection ◽  
Occult Metastasis ◽  
Initial Node ◽  
Node Positive ◽  
Node Positive Disease ◽  
Salvage Laryngectomy

Abstract Background There is controversy regarding management of the neck at salvage laryngectomy. The aim of this study was to perform an analysis to determine the incidence of occult node positivity in this group and analyse factors affecting it. Method A retrospective analysis of 171 patients who underwent salvage total laryngectomy between 2000 and 2015 for recurrent or residual disease following definitive non-surgical treatment and were clinico-radiologically node negative at the time salvage laryngectomy was carried out. Results A total of 171 patients with laryngeal or hypopharyngeal cancers underwent concurrent neck dissection at laryngectomy. There were 162 patients (94.7 per cent) who underwent bilateral neck dissection, and 9 patients (5.3 per cent) who underwent ipsilateral neck dissection. The occult lateral nodal metastasis rate was 10.5 per cent. Of various factors, initial node positive disease was the only factor predicting occult metastasis on univariable and multivariable analysis (p = 0.001). Conclusion Risk of occult metastasis is high in patients who have node positive disease before starting radiotherapy. This group should be offered elective neck dissection.

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

2019 ◽  
Vol 133 (09) ◽  
pp. 788-791
Author(s):  
M Gouzos ◽  
O Dale ◽  
N Sethi ◽  
A Foreman ◽  
S Krishnan ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Neck Dissection ◽  
Squamous Cell ◽  
Elective Neck Dissection ◽  
Survival Outcomes ◽  
Pharyngocutaneous Fistula ◽  
Complication Rates ◽  
True Value ◽  
Salvage Laryngectomy

AbstractObjectivesThis 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.MethodsA 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.ResultsTwenty-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.ConclusionIn 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.

Multicenter phase III trial of adjuvant chemoradiotherapy in stomach tumors 2 (ARTIST 2).

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. TPS228-TPS228 ◽  
Author(s):  
Se Hoon Park ◽  
Su Jin Lee ◽  
Seung Tae Kim ◽  
Jeeyun Lee ◽  
Joon Oh Park ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Statistical Power ◽  
Residual Disease ◽  
Disease Free Survival ◽  
Intestinal Type ◽  
Phase Iii ◽  
Adjuvant Chemoradiotherapy ◽  
Phase Iii Trial ◽  
Node Positive ◽  
Node Positive Disease

TPS228 Background: Treatment of gastric cancer (GC) has some notable differences between Asia and Western countries including the extent of surgery and the type of adjuvant therapy. In ARTIST trial comparing adjuvant chemotherapy involving capecitabine plus cisplatin with chemoradiotherapy, we reported comparable disease-free survival (DFS) in Korean patients with D2-resected GC. In subset analyses, patients with node-positive disease and intestinal type GC may have benefit with the addition of radiotherapy to adjuvant chemotherapy. Methods: ARTIST 2 (ClinicalTrials.gov, NCT0176146) is a 3-arm, multi-center, open-label phase III trial comparing adjuvant chemotherapy involving S-1 (40 mg/m2 bid 4-weeks-on/2-weeks-off) for one year (arm A) with S-1 plus oxaliplatin (SOX, S-1 40 mg/m2 bid 2-weeks-on/1-week-off plus oxaliplatin 130 mg/m2 iv on day 1) for 8 cycles (arm B) and chemoradiotherapy (arm C). Arm C patients receive SOX for 2 cycles, then concurrent chemoradiotherapy 45 Gy with S-1 40 mg bid daily, followed by additional SOX for 4 more cycles. Patients are randomized 1:1:1 with 3 strata: stage (II or III), type of surgery (subtotal or total gastrectomy) and Lauren classification (diffuse or intestinal type). Eligibility criteria include gastric or gastro-esophageal junction adenocarcinoma, D2 or higher surgery with no residual disease, pathologic stages 2 or 3, lymph node positive disease. Primary endpoint is DFS, and secondary endpoints include overall survival, safety, QOL and molecular biomarkers. To test if experimental arms (arm B or C) lower the hazard of recurrence by 50% (i.e., HR 1.5) compared to arm A, we need 900 patients (300 per arm) with 90% of overall statistical power. First patient entered onto the study in Feb 2013. As of Aug 2014, a total of 118 (13% of target) patients were recruited by 8 Korean tertiary centers. Clinical trial information: NCT0176146.

Outcomes and Oncologic Considerations for Elective Neck Dissection in Patients Undergoing Salvage Laryngectomy

2014 ◽  
Vol 151 (1_suppl) ◽  
pp. P61-P61
Author(s):  
Rachel A. Giese ◽  
Emre A. Vural ◽  
Mauricio A. Moreno
Keyword(s):  
Neck Dissection ◽  
Elective Neck Dissection ◽  
Salvage Laryngectomy

Elective neck dissection during salvage laryngectomy: A systematic review and meta‐analysis

2020 ◽  
Vol 130 (4) ◽  
pp. 899-906 ◽  
Author(s):  
Jennifer H. Gross ◽  
Peter M. Vila ◽  
Laura Simon ◽  
Zain H. Rizvi ◽  
Joseph Zenga ◽  
...  
Keyword(s):  
Systematic Review ◽  
Neck Dissection ◽  
Meta Analysis ◽  
Elective Neck Dissection ◽  
Salvage Laryngectomy

The role of elective neck dissection in patients undergoing salvage laryngectomy

Head & Neck ◽  
2012 ◽  
pp. n/a-n/a ◽  
Author(s):  
Moran Amit ◽  
Ohad Hilly ◽  
Leonor Leider-Trejo ◽  
Aharon Popovtzer ◽  
Orit Gutfeld ◽  
...  
Keyword(s):  
Neck Dissection ◽  
Elective Neck Dissection ◽  
Salvage Laryngectomy

scholarly journals Role of Selective Neck Dissection in Primary T1, T2, N0 Neck Oral Tongue Carcinoma

2021 ◽  
Vol 27 (2) ◽  
pp. 130-138
Author(s):  
Mohammad Nazrul Islam ◽  
Kazi Shameemus Salam ◽  
Belayat Hossain Siddique ◽  
Md Lutfor Rahman ◽  
Rashedul Islam ◽  
...  
Keyword(s):  
Lymph Node ◽  
Neck Dissection ◽  
Cervical Lymph Node ◽  
Nodal Metastasis ◽  
Selective Neck Dissection ◽  
Occult Metastasis ◽  
Tongue Carcinoma ◽  
Oral Tongue ◽  
N0 Neck ◽  
Number Of Patients

Background: Oral tongue is one of the common site for carcinoma. 22% to 39% of oral cancer develops at this site. The high incidence of cervical lymph node metastasis, occult cervical metastasis, Provide a logical basis for treatment of the neck. The aim of this is study was to find out the importance of selective neck dissection in primary T1, T2, N0 Neck Oral Tongue Carcinoma. Methods: This cross-sectional study was conducted in the Department of Otolaryngology- Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka Medical College Hospital and National Institute of ENT, Dhaka. Thirty cases of primary T1, T2, N0 Neck Oral Tongue Carcinoma with inclusion criteria was enrolled as a study sample. Patients were evaluated by a complete clinical head and neck examination as well as Imaging (MRI) of the primary tumor and neck. All the data were compiled and sorted properly and the numerical data were analyzed statistically. The results were expressed as percentage and mean ± SD. Chi-square (x2) test or Fisher’s Exact test was done for comparison of data presented in categorical value and p value <0.05 was considered as the level of significance. Among the patients 23(76.7%) were T1 lesion and remaining 7(23.33%) were T2 lesion. Extended Supraomohyoid Selective Neck Dissection (SOSD) (I-IV) was done in all patients. Following histopathological examination, 8(26.67%) patients of N0 neck became positive for nodal metastasis. Results: The study showed that most commonly (50%) involved group of occult metastasis was upper deep cervical lymph node in submandibular area (level-I). Occult nodal metastasis was significantly common 87.5% among male patients than females (p=0.039) and also common 87.5% among <50 years age group (p=0.023). Neck node positive was significantly more 62.5% in T2 lesion (p=0.002) of oral tongue carcinoma. Conclusion: In this study, we found that a number of patients had been histopathologicallly detected micro-metastases in regional neck nodes in clinically N0 patients.So, Extended Supraomohyoid Selective neck dissection (I-IV) was appropriate in T1,T2, N0 Neck Oral Tongue Carcinoma. Bangladesh J Otorhinolaryngol 2021; 27(2): 130-138

scholarly journals Is elective neck dissection necessary in cases of laryngeal recurrence after previous radiotherapy for early glottic cancer?

2014 ◽  
Vol 128 (12) ◽  
pp. 1089-1094 ◽  
Author(s):  
A Deganello ◽  
G Meccariello ◽  
B Bini ◽  
F Paiar ◽  
R Santoro ◽  
...  
Keyword(s):  
Neck Dissection ◽  
Positive Node ◽  
Glottic Cancer ◽  
Elective Neck Dissection ◽  
Recurrent Tumour ◽  
Node Negative ◽  
Early Glottic Cancer ◽  
Node Positive ◽  
Laryngeal Surgery ◽  
Curative Radiotherapy

AbstractObjectives:To assess the clinical utility of elective neck dissection in node-negative recurrent laryngeal carcinoma after curative radiotherapy for initial early glottic cancer.Methods:A retrospective review was undertaken of 110 consecutive early glottic cancer patients who developed laryngeal recurrence after radiotherapy (34 recurrent T1, 36 recurrent T2, 29 recurrent T3 and 11 recurrent T4a) and received salvage laryngeal surgery between 1995 and 2005.Results:Six patients presented with laryngeal and neck recurrence and underwent salvage laryngectomy with therapeutic neck dissection, 97 patients with recurrent node-negative tumours underwent salvage laryngeal surgery without neck dissection and only 7 underwent elective neck dissection. No occult positive lymph nodes were documented in neck dissection specimens. During follow up, only three patients with neck failure were recorded, all in the group without neck dissection. There was no significant association between the irradiation field (larynx plus neck vs larynx) and the development of regional failure. A higher rate of post-operative pharyngocutaneous fistula development occurred in the neck dissection group than in the group without neck dissection (57.2 per cent vs 13.4 per cent, p = 0.01). Multivariate logistic regression analysis showed that early (recurrent tumour-positive, node-positive) or delayed (recurrent tumour-positive, node-negative) neck relapse was not significantly related to the stage of the initial tumour or the recurrent tumour. An age of less than 60 years was significantly associated with early neck failure (recurrent tumour-positive, node-positive).Conclusion:Owing to the low occult neck disease rate and high post-operative fistula rate, elective neck dissection is not recommended for recurrent node-negative laryngeal tumours after radiation therapy if the initial tumour was an early glottic cancer.

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