Elective Paratracheal Lymph Node Dissection in Salvage Laryngectomy

• Published in: Annals of surgical oncology Vol. 26; no. 8; pp. 2542 - 2548
• Main Authors: Farlow, Janice L., Birkeland, Andrew C., Rosko, Andrew J., VanKoevering, Kyle, Haring, Catherine T., Smith, Joshua D., Brenner, J. Chad, Shuman, Andrew G., Chinn, Steven B., Stucken, Chaz L., Malloy, Kelly M., Moyer, Jeffrey S., Casper, Keith A., McLean, Scott A., Prince, Mark E. P., Bradford, Carol R., Wolf, Gregory T., Chepeha, Douglas B., Spector, Matthew E.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-08-2019; Springer Nature B.V
• Subjects: Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; CARCINOMAS; Elective Surgical Procedures - mortality; Female; Follow-Up Studies; Head and Neck Oncology; Humans; Hypocalcemia; Laryngeal Neoplasms - pathology; Laryngeal Neoplasms - surgery; LARYNGECTOMY; Laryngectomy - mortality; Lymph Node Excision - mortality; Lymph nodes; Lymph Nodes - pathology; Lymph Nodes - surgery; Male; Medicine; Medicine & Public Health; METASTASES; Metastasis; Middle Aged; Multivariate analysis; NECK; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - surgery; Oncology; PATIENTS; Prognosis; RADIOLOGY AND NUCLEAR MEDICINE; Retrospective Studies; Salvage Therapy; Squamous cell carcinoma; Surgery; Surgical Oncology; Survival Rate; Tracheal Neoplasms - pathology; Tracheal Neoplasms - surgery; Tumors
• ISSN: 1068-9265; 1534-4681; 1534-4681
• DOI: 10.1245/s10434-019-07270-6

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.