Elective neck treatment during salvage (pharyngo) laryngectomy

Purpose This study aimed at determining the importance of an elective neck dissection (END) in case of a cN0 laryngeal or hypopharyngeal carcinoma after (chemo) radiation. Methods Retrospective review was made of patients treated in a single tertiary center between 2002 and 2014. Influence of an END in case of a cN0 salvage laryngectomy on complications, recurrence-free survival and disease-specific survival was assessed. Inclusion criteria: squamous cell carcinoma and cN0 neck. Exclusion criteria: second primary tumor in the head and neck, a total laryngectomy because of a dysfunctional larynx, or a previously performed neck dissection. Results Of the 86 included patients, 27 (31%) underwent an END, of which 1 had occult metastasis (4%). Of the remaining 59 patients (69%) without an END, 3 developed a regional recurrence (5%). The overall survival was significantly higher for patients who had an END (p=0.037). The incidence of complications was not significantly different between the two groups. Conclusions In light of the limited complications of an END and the poor prognosis of regional recurrence after previous (chemo)radiotherapy and a (pharyngo)laryngectomy, we advise consideration of an END at the time of a salvage laryngectomy.

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