Department of Head Neck Surgical Oncology, Narayana Superspeciality Hospital, Gurugram, India.
Department of Head Neck Services, Tata Memorial Hospital, Mumbai, India.
J Laryngol Otol. 2021 Sep;135(9):785-790. doi: 10.1017/S0022215121001808. Epub 2021 Jul 9.
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.
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.
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).
Risk of occult metastasis is high in patients who have node positive disease before starting radiotherapy. This group should be offered elective neck dissection.
在挽救性喉切除术的颈部管理方面存在争议。本研究的目的是进行分析，以确定该组隐匿性淋巴结阳性的发生率，并分析影响其发生的因素。
回顾性分析了 171 例患者，这些患者在 2000 年至 2015 年间因明确的非手术治疗后复发或残留疾病而接受挽救性全喉切除术，且在挽救性喉切除术时临床和影像学检查淋巴结均为阴性。
共有 171 例喉癌或下咽癌患者在喉切除术时同时进行了颈部淋巴结清扫术。162 例患者（94.7%）行双侧颈部淋巴结清扫术，9 例患者（5.3%）行同侧颈部淋巴结清扫术。隐匿性侧方淋巴结转移率为 10.5%。在单变量和多变量分析中，初始淋巴结阳性疾病是唯一预测隐匿性转移的因素（p=0.001）。
在开始放疗前患有淋巴结阳性疾病的患者，隐匿性转移的风险很高。这组患者应接受选择性颈部淋巴结清扫术。
