Elective neck dissection for NO neck during salvage total laryngectomy: Findings, complications, and oncological outcome

IMPORTANCE Optimum management of the clinically negative neck in the presence of primary site recurrence of laryngeal or hypopharyngeal cancer remains unclear. OBJECTIVE To examine the incidence of occult cervical nodal metastatic disease in patients undergoing salvage laryngectomy with necks clinically staged as NO at the time of recurrence and to define the role of elective neck dissection in this population with regard to risk of complications and oncologic outcomes. DESIGN Retrospective study of patients treated from 1996 through 2011. SETTING Academic teaching hospital. PARTICIPANTS All patients undergoing salvage total laryngectomy for squamous cell carcinoma of larynx or hypopharynx after failed initial radiotherapy or chemoradiotherapy with radiographically NO neck at time of recurrence. MAIN OUTCOMES AND MEASURES Primary outcome measurewas incidence of cervical nodal metastases detected by means of pathological examination of elective neck dissection specimens. Secondary outcome measures were incidence of major postoperative complications and regional cancer control. RESULTS Forty-five patients were included. Thirty-eight underwent elective unilateral (20) or bilateral (18) ND at the time of laryngectomy. Three patients (8%) had occult metastases (3 of 56 dissected heminecks [5%]). The incidence of major wound complications was significantly greater in patients undergoing bilateral ND (12 of 18 [67%]) than in patients undergoing unilateral or no ND (8 of 27 [30%]) (P = .03). There was no significant difference in regional control according to whether bilateral, unilateral, or no ND was performed. CONCLUSIONS AND RELEVANCE The incidence of occult metastatic disease in NO necks in patients undergoing salvage surgery after radiotherapy is low. Neck dissection in this population does not seem to have a significant impact on regional cancer control. The need for elective ND, particularly bilateral ND, should be balanced against possible increased risk of morbidity in this group.