D Riviere1, J Mancini2, L Santini3, A Loth Bouketala3, A Giovanni3, P Dessi3, N Fakhry4. 1. Service d'ORL et de chirurgie cervico-faciale, centre hospitalier universitaire de la conception, Aix-Marseille université, 147, boulevard Baille, 13005 Marseille, France; École du Val-de-Grâce, 75005 Paris, France. 2. UMR912, IRD, SESSTIM, 13005 Marseille, France; Inserm, UMR912, SESSTIM, 13005 Marseille, France; BiosTIC, hôpital de la Timone, Assistance publique des hôpitaux de Marseille (AP-HM), 13005 Marseille, France. 3. Service d'ORL et de chirurgie cervico-faciale, centre hospitalier universitaire de la conception, Aix-Marseille université, 147, boulevard Baille, 13005 Marseille, France. 4. Service d'ORL et de chirurgie cervico-faciale, centre hospitalier universitaire de la conception, Aix-Marseille université, 147, boulevard Baille, 13005 Marseille, France. Electronic address: nicolas.fakhry@ap-hm.fr.
Abstract
OBJECTIVES: Neck dissection is a controversial surgical procedure in patients with squamous cell carcinoma of the Larynx free of any node metastasis detected in preoperative staging. The aim of this study was to investigate the distributions of lymph node metastases in laryngeal squamous cell carcinoma and improve the rationale for elective treatment of N0 neck. MATERIAL AND METHODS: Retrospective single-center series of Seventy-eight successive patients with laryngeal squamous cell carcinoma who underwent neck dissection between 2008 and 2015. RESULTS: Surgery was first-line treatment in 37 patients (47%) and for recurrent disease in 41 (53%). The rate of occult nodal metastasis was 14% (n=11): levels IIa and/or III were affected in 9 cases (11.5%) compared with single cases of IIb and IV involvement (1.3% each). The rate of occult nodal metastasis was significantly lower among patients operated on for recurrent disease after radiotherapy than in patients who never had any radiotherapy of the cervical lymph nodes (0% vs. 16.7%, P=0.03). CONCLUSIONS: Selective cervical lymph node dissection in levels IIa and III sparing levels IIb and IV seems to be ideal in total laryngectomy in patients with cN0 laryngeal squamous cell carcinoma. Omitting lymph node dissection altogether may be considered in total laryngectomy on a cN0 patient showing recurrence after radiotherapy.
OBJECTIVES: Neck dissection is a controversial surgical procedure in patients with squamous cell carcinoma of the Larynx free of any node metastasis detected in preoperative staging. The aim of this study was to investigate the distributions of lymph node metastases in laryngeal squamous cell carcinoma and improve the rationale for elective treatment of N0 neck. MATERIAL AND METHODS: Retrospective single-center series of Seventy-eight successive patients with laryngeal squamous cell carcinoma who underwent neck dissection between 2008 and 2015. RESULTS: Surgery was first-line treatment in 37 patients (47%) and for recurrent disease in 41 (53%). The rate of occult nodal metastasis was 14% (n=11): levels IIa and/or III were affected in 9 cases (11.5%) compared with single cases of IIb and IV involvement (1.3% each). The rate of occult nodal metastasis was significantly lower among patients operated on for recurrent disease after radiotherapy than in patients who never had any radiotherapy of the cervical lymph nodes (0% vs. 16.7%, P=0.03). CONCLUSIONS: Selective cervical lymph node dissection in levels IIa and III sparing levels IIb and IV seems to be ideal in total laryngectomy in patients with cN0 laryngeal squamous cell carcinoma. Omitting lymph node dissection altogether may be considered in total laryngectomy on a cN0 patient showing recurrence after radiotherapy.
Authors: Arne Böttcher; Christian S Betz; Stefan Bartels; Bjoern Schoennagel; Adrian Münscher; Lara Bußmann; Chia-Jung Busch; Steffen Knopke; Eric Bibiza; Nikolaus Möckelmann Journal: J Cancer Res Clin Oncol Date: 2020-08-18 Impact factor: 4.553