Department of Otolaryngology-Head and Neck Surgery, South Infirmary-Victoria University Hospital, Cork, Ireland.
JAMA Otolaryngol Head Neck Surg. 2013 Aug 1;139(8):790-6. doi: 10.1001/jamaoto.2013.3995.
Optimum management of the clinically negative neck in the presence of primary site recurrence of laryngeal or hypopharyngeal cancer remains unclear.
To examine the incidence of occult cervical nodal metastatic disease in patients undergoing salvage laryngectomy with necks clinically staged as N0 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.
Retrospective study of patients treated from 1996 through 2011.
Academic teaching hospital.
All patients undergoing salvage total laryngectomy for squamous cell carcinoma of larynx or hypopharynx after failed initial radiotherapy or chemoradiotherapy with radiographically N0 neck at time of recurrence.
Primary outcome measure was 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.
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.
The incidence of occult metastatic disease in N0 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.
在喉或下咽癌原发部位复发时，对于临床检查无颈部转移的患者，最佳的颈部管理仍不明确。
研究在复发时临床分期为 N0 的患者中，行挽救性喉切除术时隐匿性颈部淋巴结转移的发生率，并确定在该人群中选择性颈部清扫术的作用，包括并发症风险和肿瘤学结果。
对 1996 年至 2011 年期间治疗的患者进行回顾性研究。
学术教学医院。
所有因初始放疗或放化疗失败后复发且影像学检查 N0 的患者，均接受挽救性全喉切除术治疗声门或下咽鳞状细胞癌。
主要观察指标是通过选择性颈部清扫术标本的病理检查检测到的颈部淋巴结转移的发生率。次要观察指标是主要术后并发症和区域性癌症控制的发生率。
共纳入 45 例患者。38 例行挽救性单侧（20 例）或双侧（18 例）颈清扫术。3 例（8%）患者存在隐匿性转移（56 个解剖半颈中 3 例[5%]）。行双侧颈清扫术的患者中，重大伤口并发症的发生率明显高于行单侧或不行颈清扫术的患者（18 例中有 12 例[67%] vs 27 例中有 8 例[30%]）（P=.03）。是否行双侧、单侧或不行颈清扫术，对区域性控制无显著影响。
放疗后行挽救性手术的 N0 颈患者隐匿性转移疾病的发生率较低。该人群中颈部清扫术似乎对区域性癌症控制无显著影响。在该组患者中，需要权衡选择性颈清扫术的必要性，尤其是双侧颈清扫术，与增加发病率的风险。
