Impact of neck dissection in cN0 patients undergoing primary or salvage total laryngectomy

Introduction: It is debatable whether neck dissection is necessary in patients with advanced laryngeal carcinoma who are clinically node-negative (cN0). We assessed the effect of neck dissection on overall survival in patients with cN0 undergoing primary or salvage laryngectomy.

Materials and methods: A retrospective evaluation of cN0 patients who underwent primary or salvage total/pharyngolaryngectomy at a French tertiary facility in 2008-2018, with or without neck dissection, was carried out. Patients were divided into two groups: primary (n = 65) and salvage (n = 84).

Results: Comparing subglottic (HR = 3.978; p = 0.023) and hypopharyngeal (HR = 2.958; p = 0.018) malignancies to other tumor subsites, the mortality rates were greater. The primary group had a greater rate of occult metastases (23.07% vs. 14.28%; p = 0.089) than the salvage. The average lymph node ratio was significantly different between the treatment groups (0.05 ± 0.04 vs. 0.17 ± 0.33; p = 0.004). If LNR > 0.05, we found poor survival rates (p < 0.001). Although performing a neck dissection during the primary treatment increased the 5-year OS rate (Yes 89.5% vs. No 83.3%; p = 0.062), there was no discernible difference in the salvage group (Yes 80.3% vs. No 78.6%; p = 0.806; Log-rank p > 0.05). For the predicted survival variables, no significant relationships were detected in the Cox regression analysis (all p-values > 0.05).

Conclusion: Although the primary group had a greater frequency of occult metastases, neither the primary group's survival outcomes nor those of the salvage laryngectomy cases were significantly affected by neck dissection. LNR and the location of the tumor were important variables that could affect survival and the choice to do a neck dissection.