Management of the N0 neck in moderately advanced squamous carcinoma of the larynx

Abstract

Objective: To assess the oncological efficacy of selective neck dissection (SND) in patients with T3-4 N0 laryngeal squamous carcinoma. Subjects and Methods: A total of 327 patients underwent 654 neck dissections; each side of the neck was individually evaluated. Results: Three percent of patients who had SND developed regional recurrence (RR) in comparison with 11.7 percent of patients who underwent modified radical neck dissection (MRND) ( P = 0.005). Only 3 (0.9%) patients developed RR outside the field of SND. The presence of extracapsular extension ( P = 0.002) in node-positive (pN+) group and of microvascular invasion ( P = 0.007), together with the type of neck dissection (ND) ( P = 0.0003) in node-negative (pN0) group had statistical impact on RR. The development of RR significantly affected disease-specific survival ( P = 0.0001). Equivalent rates of RR were found in pN+ (2.6%) or pN0 (3.2%) patients treated with SND ( P = 0.98) as well as in pN+ patients who underwent SND (2.6%) or MRND (4.7%) ( P = 0.85). Conclusion: This study confirmed the adequacy of SND as a satisfactory staging and therapeutic procedure, and suggests its use in the treatment of limited node-positive (N+) neck.