Galli Jacopo, Di Cintio Giovanni, Settimi Stefano, Salvati Antonio, Parrilla Claudio, Almadori Giovanni, Paludetti Gaetano
Unit of Otolaryngology-Head and Neck Surgery, "A. Gemelli" Hospital Foundation IRCCS, 00168 Rome, Italy.
Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy.
J Clin Med. 2022 Mar 5;11(5):1438. doi: 10.3390/jcm11051438.
The role of elective neck dissection during salvage surgery in patients with a clinically negative neck (cN0) is still discussed. The main objective of this work was to estimate the prevalence and predictive factors of occult neck nodes metastasis; we therefore aimed to evaluate the survival rate and the main oncologic outcomes of cN0 patients who underwent salvage total laryngectomy and elective bilateral neck dissection. In this retrospective observational study, we enrolled 80 cN0 patients affected by recurrent laryngeal cancer and who underwent salvage total laryngectomy and bilateral selective elective neck dissection. Several parameters were collected in order to find prognostic factors; finally, postoperative complications were reviewed and survival analysis was performed. Occult lymph node metastases were reported in 18 out of 80 patients (22.5%). Significant statistical correlation between lymphovascular invasion ( = 0.007), perineural invasion ( = 0.025) and occult nodal metastasis was found. Other variables (glottic subsite of recurrence, clinical T, pathological T, previous chemotherapy) were not significantly predictive of occult nodal metastasis. The 5-year OS, DSS, and RFS were 50.4%, 64.7%, and 63.4%, respectively. In conclusion, our single-institution data on a large cohort of patients, suggest performing routinely elective selective bilateral neck dissection during salvage total laryngectomy in cN0 patients due to the biological attitude of the tumor to spread to cervical nodes, considering an acceptable complications rate.
对于临床颈部阴性（cN0）患者，在挽救性手术中进行选择性颈部清扫的作用仍存在争议。这项研究的主要目的是评估隐匿性颈部淋巴结转移的发生率及预测因素；因此，我们旨在评估接受挽救性全喉切除术和选择性双侧颈部清扫的cN0患者的生存率及主要肿瘤学结局。在这项回顾性观察研究中，我们纳入了80例复发性喉癌且接受挽救性全喉切除术和双侧选择性颈部清扫的cN0患者。收集了多个参数以寻找预后因素；最后，对术后并发症进行了回顾并进行了生存分析。80例患者中有18例（22.5%）报告有隐匿性淋巴结转移。发现淋巴管侵犯（P = 0.007）、神经周围侵犯（P = 0.025）与隐匿性淋巴结转移之间存在显著的统计学相关性。其他变量（复发的声门亚部位、临床T分期、病理T分期、既往化疗）对隐匿性淋巴结转移无显著预测作用。5年总生存率、无病生存率和无复发生存率分别为50.4%、64.7%和63.4%。总之，我们单机构对大量患者的数据表明，鉴于肿瘤向颈部淋巴结转移的生物学特性，在cN0患者进行挽救性全喉切除术时常规进行选择性双侧颈部清扫是可行的，同时考虑到并发症发生率可接受。
