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Nodal yield of neck dissections and influence on outcome in laryngectomized patients

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Abstract

The appropriate extent of neck dissection (ND) in head and neck squamous cell carcinoma (SCC) continues to be investigated. This study aimed to determine whether the extent of ND as measured by nodal yield (NY) is a prognostic factor in patients undergoing primary total laryngectomy (TL) for advanced laryngeal SCC. A retrospective review at a tertiary referral centre identified 54 patients who underwent TL with elective (n = 39, cN0) or therapeutic (n = 15, cN+) ND with curative intent between 2002 and 2014. Survival analysis was obtained via regression analysis, calculated for overall (OS) and disease-free survival (DFS). Stage-independent 5-year OS was 32.1 %. Mean NY was 18.67 (standard deviation 9.898; range 0–45). The rate of cervical lymph node metastasis on pathology (pN+) was 27.8 %. Uni- and multivariate regression analysis detected no association between NY and OS or DFS (P ≥ 0.05). Advantages in OS and DFS were seen among patients without cervical lymph node metastasis (pN0) in comparison to those with pN+ necks (OS: hazard ratio [HR] 0.179; 95 % confidence interval [CI] 0.046–0.693; P = 0.013, and DFS: HR 0.190; 95 % CI 0.061–0.590; P = 0.004). ND resulted in pathologic upstaging of the neck in seven patients and downgrading in eight; increasing NY was not associated with an increased probability of a change in nodal stage. No significant association was found between NY and OS or DFS in patients undergoing TL with ND as primary therapy for advanced laryngeal SCC.

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Acknowledgments

The authors would like to thank Dietmar Keune and Dr. Joachim Bellach from the CCR of the CCCC for their helpful advise concerning critical statistics review.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, Charité - University Medical Center Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

    Arne Böttcher, Heidi Olze & Steffen Knopke

  2. Department of Otorhinolaryngology, Head and Neck Surgery, Charité - University Medical Center Berlin, Campus Charité Mitte, Berlin, Germany

    Steffen Dommerich & Heidi Olze

  3. Clinical Cancer Registry, Charité Comprehensive Cancer Center (CCCC), Charité - University Medical Center Berlin, Campus Charité Mitte, Berlin, Germany

    Steffen Sander

  4. Department of Radiooncology, Charité - University Medical Center Berlin, Campus Virchow-Klinikum, Berlin, Germany

    Carmen Stromberger

  5. Department of Otorhinolaryngology, Head and Neck Surgery, Charité - University Medical Center Berlin, Campus Benjamin Franklin, Berlin, Germany

    Annekatrin Coordes

  6. Department of Otolaryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA, USA

    Nate Jowett

Authors
  1. Arne Böttcher
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  2. Steffen Dommerich
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  3. Steffen Sander
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  4. Heidi Olze
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  6. Annekatrin Coordes
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  7. Nate Jowett
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  8. Steffen Knopke
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Corresponding author

Correspondence to Arne Böttcher.

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The authors have no conflicts to declare.

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N. Jowett and S. Knopke have shared senior authorship.

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Böttcher, A., Dommerich, S., Sander, S. et al. Nodal yield of neck dissections and influence on outcome in laryngectomized patients. Eur Arch Otorhinolaryngol 273, 3321–3329 (2016). https://doi.org/10.1007/s00405-016-3928-2

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  • DOI: https://doi.org/10.1007/s00405-016-3928-2

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