Skip to main content

Advertisement

SpringerLink
Log in

Elective Paratracheal Lymph Node Dissection in Salvage Laryngectomy

  • Head and Neck Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Indications for and efficacy of paratracheal nodal dissection (PTND) in patients undergoing laryngectomy (salvage) for persistent or recurrent laryngeal squamous cell carcinoma are not well-defined.

Methods

A retrospective cohort study was performed for patients undergoing salvage laryngectomy with clinically and radiographically negative neck disease between 1998 and 2015 (n = 210). Univariate and multivariate Cox regression analyses were performed.

Results

PTND was performed on 77/210 patients (36%). The PTND cohort had a greater proportion of advanced T classification (rT3/rT4) tumors (78%) than subjects without PTND (55%; p = 0.001). There was a 14% rate of occult nodal metastases in the paratracheal basin; of these, 55% did not have pathologic lateral neck disease. Multivariate analysis controlling for tumor site, tumor stage, and pathologic lateral neck disease demonstrated that PTND was associated with improved overall survival [OS] (p = 0.03; hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.38–0.96), disease-free survival [DFS] (p = 0.03; HR 0.55, 95% CI 0.31–0.96), and distant DFS survival (p = 0.01; HR 0.29, 95% CI 0.11–0.77). The rate of hypocalcemia did not differ between subjects who underwent bilateral PTND, unilateral PTND, or no PTND (p = 0.19 at discharge, p = 0.17 at last follow-up).

Conclusions

PTND at the time of salvage laryngectomy was more common in patients with rT3/rT4 tumors and was associated with improved OS and DFS, with no effect on hypocalcemia. In patients undergoing PTND, the finding of occult paratracheal metastases was often independent of lateral neck metastases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Noone A, Howlader N, Krapcho M, et al. SEER cancer statistics review. 1975–2015. Available at: https://seer.cancer.gov/csr/1975_2015/.

  2. Department of Veterans Affairs Laryngeal Cancer Study Group, Wolf GT, Fisher SG, et al. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med. 1991;324(24):1685–90.

    Article  Google Scholar 

  3. Forastiere AA, Zhang Q, Weber RS, et al. Long-term results of RTOG 91-11: a comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. J Clin Oncol. 2013;31(7):845–52.

    Article  CAS  PubMed  Google Scholar 

  4. Lefebvre JL, Andry G, Chevalier D, et al. Laryngeal preservation with induction chemotherapy for hypopharyngeal squamous cell carcinoma: 10-year results of EORTC trial 24891. Ann Oncol. 2012;23(10):2708–14.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Urba S, Wolf G, Eisbruch A, et al. Single-cycle induction chemotherapy selects patients with advanced laryngeal cancer for combined chemoradiation: a new treatment paradigm. J Clin Oncol. 2006;24(4):593–8.

    Article  CAS  PubMed  Google Scholar 

  6. Agra IM, Ferlito A, Takes RP, et al. Diagnosis and treatment of recurrent laryngeal cancer following initial nonsurgical therapy. Head Neck. 2012;34(5):727–35.

    Article  PubMed  Google Scholar 

  7. Forastiere AA, Ismaila N, Wolf GT. Use of larynx-preservation strategies in the treatment of laryngeal cancer: American Society of Clinical oncology clinical practice guideline update summary. J Oncol Pract. 2018;14(2):123–8.

    Article  PubMed  Google Scholar 

  8. Weber RS, Berkey BA, Forastiere A, et al. Outcome of salvage total laryngectomy following organ preservation therapy: the Radiation Therapy Oncology Group trial 91–11. Arch Otolaryngol Head Neck Surg. 2003;129(1):44–9.

    Article  PubMed  Google Scholar 

  9. Basheeth N, O’Leary G, Sheahan P. Elective neck dissection for no neck during salvage total laryngectomy: findings, complications, and oncological outcome. JAMA Otolaryngol Head Neck Surg. 2013;139(8):790–6.

    Article  PubMed  Google Scholar 

  10. Bohannon IA, Desmond RA, Clemons L, Magnuson JS, Carroll WR, Rosenthal EL. Management of the N0 neck in recurrent laryngeal squamous cell carcinoma. Laryngoscope. 2010;120(1):58–61.

    PubMed  Google Scholar 

  11. Farrag TY, Lin FR, Cummings CW, et al. Neck management in patients undergoing postradiotherapy salvage laryngeal surgery for recurrent/persistent laryngeal cancer. Laryngoscope. 2006;116(10):1864–6.

    Article  PubMed  Google Scholar 

  12. Hilly O, Stern S, Horowitz E, Leshno M, Feinmesser R. Is there a role for elective neck dissection with salvage laryngectomy? A decision-analysis model. Laryngoscope. 2013;123(11):2706–11.

    Article  PubMed  Google Scholar 

  13. Koss SL, Russell MD, Leem TH, Schiff BA, Smith RV. Occult nodal disease in patients with failed laryngeal preservation undergoing surgical salvage. Laryngoscope. 2014;124(2):421–8.

    Article  PubMed  Google Scholar 

  14. Pezier TF, Nixon IJ, Scotton W, et al. Should elective neck dissection be routinely performed in patients undergoing salvage total laryngectomy? J Laryngol Otol. 2014;128(3):279–83.

    Article  CAS  PubMed  Google Scholar 

  15. Spector GJ, Sessions DG, Lenox J, Newland D, Simpson J, Haughey BH. Management of stage IV glottic carcinoma: therapeutic outcomes. Laryngoscope. 2004;114(8):1438–46.

    Article  PubMed  Google Scholar 

  16. Basheeth N, O’Cathain E, O’Leary G, Sheahan P. Hypocalcemia after total laryngectomy: incidence and risk factors. Laryngoscope. 2014;124(5):1128–33.

    Article  PubMed  Google Scholar 

  17. Giordano D, Valcavi R, Thompson GB, et al. Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature. Thyroid. 2012;22(9):911–7.

    Article  PubMed  Google Scholar 

  18. Lo Galbo AM, de Bree R, Kuik DJ, Lips P, Leemans CR. Paratracheal lymph node dissection does not negatively affect thyroid dysfunction in patients undergoing laryngectomy. Eur Arch Otorhinolaryngol. 2010;267(5):807–10.

    Article  PubMed  Google Scholar 

  19. Viola D, Materazzi G, Valerio L, et al. Prophylactic central compartment lymph node dissection in papillary thyroid carcinoma: clinical implications derived from the first prospective randomized controlled single institution study. J Clin Endocrinol Metab. 2015;100(4):1316–24.

    Article  CAS  PubMed  Google Scholar 

  20. American Joint Committee on Cancer. AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer; 2010.

    Book  Google Scholar 

  21. Robbins KT. Indications for selective neck dissection: when, how, and why. Oncology (Williston Park). 2000;14(10):1455–64; discussion 1467–1459.

    CAS  Google Scholar 

  22. Birkeland AC, Beesley L, Bellile E, et al. Predictors of survival after total laryngectomy for recurrent/persistent laryngeal squamous cell carcinoma. Head Neck. 2017;39(12):2512–8.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Candela FC, Kothari K, Shah JP. Patterns of cervical node metastases from squamous carcinoma of the oropharynx and hypopharynx. Head Neck. 1990;12(3):197–203.

    Article  CAS  PubMed  Google Scholar 

  24. Suarez C, Rodrigo JP, Robbins KT, et al. Superselective neck dissection: rationale, indications, and results. Eur Arch Otorhinolaryngol. 2013;270(11):2815–21.

    Article  PubMed  Google Scholar 

  25. Birkeland AC, Rosko AJ, Issa MR, et al. Occult nodal disease prevalence and distribution in recurrent laryngeal cancer requiring salvage laryngectomy. Otolaryngol Head Neck Surg. 2016;154(3):473–9.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Medina JE, Ferlito A, Robbins KT, et al. Central compartment dissection in laryngeal cancer. Head Neck. 2011;33(5):746–52.

    Article  PubMed  Google Scholar 

  27. Chiesa F, Tradati N, Calabrese L, et al. Surgical treatment of laryngeal carcinoma with subglottis involvement. Oncol Rep. 2001;8(1):137–40.

    CAS  PubMed  Google Scholar 

  28. Timon CV, Toner M, Conlon BJ. Paratracheal lymph node involvement in advanced cancer of the larynx, hypopharynx, and cervical esophagus. Laryngoscope. 2003;113(9):1595–9.

    Article  PubMed  Google Scholar 

  29. Weber RS, Marvel J, Smith P, Hankins P, Wolf P, Goepfert H. Paratracheal lymph node dissection for carcinoma of the larynx, hypopharynx, and cervical esophagus. Otolaryngol Head Neck Surg. 1993;108(1):11–17.

    Article  CAS  PubMed  Google Scholar 

  30. Plaat RE, de Bree R, Kuik DJ, et al. Prognostic importance of paratracheal lymph node metastases. Laryngoscope. 2005;115(5):894–8.

    Article  PubMed  Google Scholar 

  31. Dagan R, Morris CG, Kirwan JM, et al. Elective neck dissection during salvage surgery for locally recurrent head and neck squamous cell carcinoma after radiotherapy with elective nodal irradiation. Laryngoscope. 2010;120(5):945–52.

    PubMed  Google Scholar 

  32. Machtay M, Moughan J, Trotti A, et al. Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis. J Clin Oncol. 2008;26(21):3582–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Narayan K, Crane CH, Kleid S, Hughes PG, Peters LJ. Planned neck dissection as an adjunct to the management of patients with advanced neck disease treated with definitive radiotherapy: for some or for all? Head Neck. 1999;21(7):606–13.

    Article  CAS  PubMed  Google Scholar 

  34. Joseph DL, Shumrick DL. Risks of head and neck surgery in previously irradiated patients. Arch Otolaryngol. 1973;97(5):381–4.

    Article  CAS  PubMed  Google Scholar 

  35. Alvarado R, Sywak MS, Delbridge L, Sidhu SB. Central lymph node dissection as a secondary procedure for papillary thyroid cancer: is there added morbidity? Surgery. 2009;145(5):514–8.

    Article  PubMed  Google Scholar 

Download references

Funding

JCB received funding from National Institutes of Health (NIH) Grants U01-DE025184, P30-CA046592 and R01-CA194536. JCB and MES also received funding from the American Head and Neck Society.

Author information

Authors and Affiliations

  1. Department of Otolaryngology – Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA

    Janice L. Farlow MD, PhD, Andrew J. Rosko MD, Kyle VanKoevering MD, Catherine T. Haring MD, Joshua D. Smith BA, J. Chad Brenner PhD, Andrew G. Shuman MD, Steven B. Chinn MD, MPH, Chaz L. Stucken MD, Kelly M. Malloy MD, Jeffrey S. Moyer MD, Keith A. Casper MD, Scott A. McLean MD, PhD, Mark E. P. Prince MD, Carol R. Bradford MD, Gregory T. Wolf MD & Matthew E. Spector MD

  2. Department of Otolaryngology – Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, CA, USA

    Andrew C. Birkeland MD

  3. Department of Otolaryngology, University of Toronto, Toronto, ON, Canada

    Douglas B. Chepeha MD, MScPH

Authors
  1. Janice L. Farlow MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew C. Birkeland MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrew J. Rosko MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kyle VanKoevering MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Catherine T. Haring MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Joshua D. Smith BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. Chad Brenner PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Andrew G. Shuman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Steven B. Chinn MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Chaz L. Stucken MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kelly M. Malloy MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Jeffrey S. Moyer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Keith A. Casper MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Scott A. McLean MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Mark E. P. Prince MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Carol R. Bradford MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Gregory T. Wolf MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Douglas B. Chepeha MD, MScPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Matthew E. Spector MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JLF, ACB, AJR, and MES contributed to the conceptualization, data curation, formal analysis, and original drafting of this manuscript. All authors made contributions to the acquisition and interpretation of data for the work, as well as to critical revision of the manuscript and final approval of the version to be submitted.

Corresponding author

Correspondence to Matthew E. Spector MD.

Ethics declarations

Conflict of interest

Janice L. Farlow, Andrew C. Birkeland, Andrew J. Rosko, Kyle VanKoevering, Catherine T. Haring, Joshua D. Smith, J. Chad Brenner, Andrew G. Shuman, Steven B. Chinn, Chaz L. Stucken, Kelly M. Malloy, Jeffrey S. Moyer, Keith A. Casper, Scott A. McLean, Mark E. P. Prince, Carol R. Bradford, Gregory T. Wolf, Douglas B. Chepeha, and Matthew E. Spector declare there are no conflict of interest in relation to this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Farlow, J.L., Birkeland, A.C., Rosko, A.J. et al. Elective Paratracheal Lymph Node Dissection in Salvage Laryngectomy. Ann Surg Oncol 26, 2542–2548 (2019). https://doi.org/10.1245/s10434-019-07270-6

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-019-07270-6

Search

Navigation