Rational surgical neck management in total laryngectomy for advanced stage laryngeal squamous cell carcinomas

• DOI: 10.1007/s00432-020-03352-1
• Publication Date: 2020-08-18T09:05:48Z
• Authors: Arne Böttcher; Christian S. Betz; Stefan Bartels; Bjoern Schoennagel; Adrian Münscher; Lara Bußmann; Chia-Jung Busch; Steffen Knopke; Eric Bibiza; Nikolaus Möckelmann
• Keywords: Adult; Aged, 80 and over; Male; Squamous Cell Carcinoma of Head and Neck; Original Article – Clinical Oncology; Laryngectomy; Middle Aged; 3. Good health; Female [MeSH] ; Aged, 80 and over [MeSH] ; Aged [MeSH] ; Squamous Cell Carcinoma of Head and Neck/pathology [MeSH] ; Adult [MeSH] ; Original Article – Clinical Oncology ; Humans [MeSH] ; Level IIB ; Retrospective Studies [MeSH] ; Middle Aged [MeSH] ; Laryngeal Neoplasms/pathology [MeSH] ; Neck Dissection/methods [MeSH] ; Squamous Cell Carcinoma of Head and Neck/surgery [MeSH] ; Neoplasm Staging [MeSH] ; Laryngeal Neoplasms/surgery [MeSH] ; HNSCC ; Male [MeSH] ; Squamous Cell Carcinoma of Head and Neck/mortality [MeSH] ; Neck dissection ; Laryngeal Neoplasms/mortality [MeSH] ; Laryngectomy/methods [MeSH] ; Advanced laryngeal cancer ; Nodal yield ; Total laryngectomy; 03 medical and health sciences; 0302 clinical medicine; Humans; Neck Dissection; Female; Laryngeal Neoplasms; Aged; Neoplasm Staging; Retrospective Studies

Abstract Purpose Controversies exist in regard to surgical neck management in total laryngectomies (TL). International guidelines do not sufficiently discriminate neck sides and sublevels, or minimal neck-dissection nodal yield (NY).

Methods Thirty-seven consecutive primary TL cases from 2009 to 2019 were retrospectively analyzed in terms of local tumor growth using a previously established imaging scheme, metastatic neck involvement, and NY impact on survival.

Results There was no case of level IIB involvement on any side. For type A and B tumor midline involvement, no positive contralateral lymph nodes were found. Craniocaudal tumor extension correlated with contralateral neck involvement (OR: 1.098, p = 0.0493) and showed increased involvement when extending 33 mm (p = 0.0134). Using a bilateral NY of ≥ 24 for 5-year overall survival (OS) and ≥ 26 for 5-year disease-free survival (DFS) gave significantly increased rate advantages of 64 and 56%, respectively (both p < 0.0001).

Conclusions This work sheds light on regional metastatic distribution pattern and its influence on TL cases. An NY of n ≥ 26 can be considered a desirable benchmark for bilateral selective neck dissections as it leads to improved OS and DFS. Therefore, an omission of distinct neck levels cannot be promoted at this time.