Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2006 Dec;26(6):335-44.

Evolution of elective neck dissection in N0 laryngeal cancer

O Gallo  1 , A Deganello, J Scala, E De Campora
Affiliations

Evolution of elective neck dissection in N0 laryngeal cancer

O Gallo et al. Acta Otorhinolaryngol Ital. 2006 Dec.

Abstract
in English, Italian

Management of cervical lymph node metastasis is one of the most challenging problems facing clinicians dealing with head and neck cancer. A retrospective evaluation has been made of results in N0 laryngeal cancer patients treated from 1978 to date by comparing historical data reported in related papers previously published by our institution. The medical records of 2207 consecutive patients with cN0 SCC of the larynx were used as the source of data in the present study. Together with primary treatment, 759 (34.4%) received at least unilateral elective neck dissection, while the remaining 1448 (65.6%) were admitted to a wait-and-see protocol. Overall, in the electively dissected patients (ED): 128 (16.9%) cases were submitted to classical radical neck dissection, while 403 (53.1%) cases were submitted to functional neck dissection (FND) and 228 (30.0%) cases to jugular node dissection (JND, removing Level II, III and IV). In 125 of the ED group, a neck procedure on the contralateral N0 neck was associated, of which 15 were RNDs, 35 FNDs and 75 JNDs, respectively. Based on this large series population, the change in the philosophy was evaluated concerning elective neck treatment in N0 laryngeal cancer, from RND through FND towards JND. As far as concerns the reliability as a staging procedure, no statistically significant difference was found between RND, FND and JND (p = 0.794). The 5-year neck recurrence rate, as estimated by the Kaplan Meier, method, for all ED patients, was 7.7%. No significant difference in the rate of 5-year neck recurrence was detected between RND, FND and JND groups (p = 0.178). In the survival curves, no differences, in terms of actuarial survival by Kaplan Meier analysis, were observed, in our series, as far as concerns type of elective neck dissection performed (p = 0.222). In conclusion, following a critical revision of 25 years' experience, at our Institution, in the management of cN0 necks in laryngeal cancer patients, definitive changes were observed in the surgical approach to the treatment of occult disease in cN0 cases. JND, compared to more extensive neck dissections, did not show statistically significant differences in terms of neck control (p = 0.233), in terms of impact on survival (p = 0.122) and in terms of accuracy as staging procedure (p = 0.794).

Il trattamento delle metastasi linfonodali laterocervicali è uno dei problemi più complessi che deve affrontare il chirurgo oncologo del distretto testa-collo. Abbiamo valutato retrospettivamente i pazienti con carcinoma laringeo N0 trattati nel nostro Istituto dal 1978 ad oggi, rivalutando i dati di precedenti pubblicazioni. Sono state considerate le cartelle cliniche di 2.207 pazienti con carcinoma squamocellulare laringeo e collo N0; di questi 759 (34,4%) sono stati sottoposti, contestualmente al trattamento chirurgico del tumoure laringeo, a svuotamento elettivo laterocervicale, mentre i rimanenti 1.448 (65,6%) sono stati sottoposti a protocollo di attesa vigile. Tra i pazienti sottoposti a svuotamento elettivo in 128 casi (16,9%) è stato praticato uno svuotamento radicale (RND), in 403 (53,1%) uno svuotamento funzionale (FND) e in 228 (30,0%) uno svuotamento laterale (JND); in 125 casi è stato associato anche uno svuotamento del collo N0 controlaterale. Basandoci su questi dati abbiamo valutato i cambiamenti della filosofia nel trattamento elettivo del collo N0 da RND attraverso FND fino a giungere alla JND. Per quanto concerne l’affidabilità come procedura di campionamento non abbiamo rilevato differenze statisticamente significative fra i diversi svuotamenti RND, FND e JND (p = 0,794).

Il tasso di recidiva a 5 anni per tutti i colli sottoposti a svuotamento elettivo è stato del 7,7% e non si sono rilevate differenze statisticamente significative tra i gruppi trattati con RND, FND e JND (p = 0,178). Non si sono rilevate differenze significative anche nelle curve di sopravvivenza (p = 0,222). Concludendo, dalla revisione critica dei 25 anni di esperienza, nel trattamento dei colli N0 da carcinoma laringeo primitivo presso il nostro Istituto, abbiamo rilevato un marcato cambiamento nella filosofia di trattamento di questi pazienti. Il JND rispetto agli svuotamenti funzionali e radicali non presenta differenze statisticamente significative per quanto riguarda il controllo regionale di malattia, la sopravvivenza e la capacità di campionamento.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Patient distribution.
Fig. 2
Fig. 2
Localization of detected micrometastases.
Fig. 3
Fig. 3
Localization of recurrences (Left number pN0+ necks, Right number pN0- necks).
Fig. 4
Fig. 4
Kaplan Meier survival curve according to surgical procedure (p = 0.222).
Fig. 5
Fig. 5
Kaplan Meier survival curve according to N0 status (p = 0.023).
Fig. 6
Fig. 6
Percentage of surgical procedures performed over the years.
Fig. 7
Fig. 7
Number of neck dissections performed over the years and percentage of occult metastases detected.
See this image and copyright information in PMC

References

    1. Kocher H. Über Radicalheilung des Krebses. Deutsche Chir 1980;13:134-66.
    1. Warren JC. Surgical observations on tumours: Cases and operations. Boston: Crocker & Brewster 1838.
    1. Butlin HT, Spencer WG. Diseases of the tongue. 2nd edn. London: Cassell 1900.
    1. Crile GW. Excision of cancer of the head and neck: with special reference to the plan of dissection based on one hundred and thirty-two operations. JAMA 1906;47:1780-6. - PubMed
    1. Martin H, Del Valle B, Ehrlich H, Cahan WB. Neck dissection. Cancer 1951;4:441-99. - PubMed

LinkOut - more resources