# Elective Neck Dissection in Patients Undergoing Salvage Laryngectomy: Outcomes, Complications, and Considerations

## TL;DR

This study examines outcomes of elective neck dissection during salvage laryngectomy, finding no survival benefit but identifying tumor stage as a predictor of hidden disease.

## Contribution

The study identifies rT3/rT4 stage as a predictor of occult nodal disease in cN0 necks during salvage laryngectomy.

## Key findings

- Advanced recurrent T-stage (rT3-rT4) is a significant predictor of occult nodal disease.
- Elective neck dissection did not improve regional recurrence-free survival or disease-specific survival.
- Positive nodes were found in levels II through IV of neck dissection specimens.

## Abstract

Objective

In this study, we sought to identify the predictors for occult nodal disease (OND) and compare oncologic outcomes in patients undergoing elective neck dissection (END) at the time of salvage laryngectomy (SLE) versus the observation group.

Methods

A retrospective chart review was conducted involving all patients with clinically node-negative (cN0) necks who underwent SLE at a tertiary academic center over 12 years. A total of 58 patients met the inclusion criteria and were divided into two groups: END (n=39) and observation (n=19). Primary endpoints were OND, regional recurrence-free survival (RRFS), and disease-specific survival (DSS). Univariate analysis was performed to establish the association between variables with Fisher’s exact test and Mann-Whitney U test. Survival analysis was performed with the log-rank test.

Results

The cohort comprised 46 (79.3%) males and 12 (20.7%) females, with a mean age of 60 years. Pathological nodal disease was identified in five of 71 (7%) examined neck dissection specimens, with positive nodes found in levels II through IV. The only statistically significant predictor of OND was the rT3/rT4 stage (p=0.017). There were no differences in perioperative complications, RRFS (p=0.216), or DSS (p=0.298) between the END and observation groups.

Conclusions

In cN0 necks, the advanced recurrent T-stage (rT3-rT4) is a predictor for OND. As OND was found involving levels II, III, and IV in this study's specimens, formal lateral neck dissection should be the procedure of choice if END is to be performed alongside SLE. While END did not show a significantly higher morbidity profile versus conservative management in this cohort, the procedure did not improve loco-regional control or survival, even when stratifying by tumor stage.