Impact of elective neck dissection vs observation on regional recurrence and survival in cN0-staged patients with squamous cell carcinomas of the upper aerodigestive tract

Abstract

Objective: To evaluate the impact of elective selective neck dissection vs observation on regional recurrence and survival in cN0-staged patients after transoral microscopic laser surgery of squamous cell carcinomas of the upper aerodigestive tract.

Design: Retrospective unicenter study performed from 1986 through 2003.

Setting: Tertiary referral center.

Patients: A total of 202 of 425 patients (48%) with previously untreated squamous cell carcinoma of the upper aerodigestive tract (T1-T4) underwent transoral laser surgery and selective neck dissection with curative intent. A total of 223 patients (52%) received tumor resection only. Stage distribution was as follows: stage I, 50 cases (12%); stage II, 216 cases (51%); stage III, 120 cases (28%); and stage IVa, 39 cases (9%).

Main outcome measures: Overall survival, recurrence-free survival.

Results: In the neck dissection group, 15% of occult metastases were found. In pN0 necks we found 4 late metastases (4%), and in pN+ necks, 1 recurrent neck metastasis (7%) (pT1-pT2) (n = 109). In patients with pT3-pT4 tumors (n = 93), 5 late neck metastases (5%) were observed. The wait-and-see group comprised 7 late metastases (4%) in patients with pT1-pT2 tumors (n = 171) and 9 late metastases (17%) in patients with pT3-pT4 tumors (n = 52). In early-stage T1-T2 tumors, the 5-year recurrence-free survival rate was 95% in the neck dissection group and 96% in the wait-and-see group. Advanced stages T3 to T4 presented a 5-year recurrence-free survival rate of 90% in the neck dissection group and 75% in the wait-and-see group. In early-stage T1-T2 tumors, the 5-year overall survival rate was 83% in the neck dissection group and 72% in the wait-and-see group. Advanced T3-T4 categories showed 5-year overall survival rates of 58% in the neck dissection group and 60% in the wait-and-see group.

Conclusions: A wait-and-see approach is justified in patients with early-stage disease. Elective selective neck dissection should be considered in patients with advanced cancer of the upper aerodigestive tract. Because of selection effects, the possible conclusions of this study are limited. There is a definite need for prospective, randomized studies.