Does a salvage laryngectomy need to include a nodal dissection by definition? Here is a retrospective look at outcomes for 107 patients receiving salvage laryngectomy for primary site-only recurrence following definitive radiation for larynx or hypopharynx tumors. Three-quarters underwent elective neck dissection and the other quarter didn’t. Of the 81 neck dissections, 13 (16%) had occult nodal disease, primarily in levels II-III for supraglottic tumors. To get at the meat of the matter, there was no difference in overall survival at 2 years whether a patient did (75%) or did not (73%) undergo elective neck dissection. Instead, the biggest indicator of distant mets (by a factor of 8) and death (by a factor of 4) was a hypopharyngeal recurrence.
- Gross, JAMA Otolaryngol Head Neck Surg 2022