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. 2018 Apr;38(2):86-93.
doi: 10.14639/0392-100X-1378.

Elective neck dissection during salvage surgery after radiotherapy in patients with head and neck squamous cell carcinoma

G Pedemonte  1 , E Esteller  2 , J-C Villatoro  2 , J-M Costa  3 , C Valero  4 , M Quer  4 , X León  5
Affiliations

Elective neck dissection during salvage surgery after radiotherapy in patients with head and neck squamous cell carcinoma

G Pedemonte et al. Acta Otorhinolaryngol Ital. 2018 Apr.

Abstract
in English, Italian

Elective neck dissection in patients with recurrent head and neck squamous cell carcinoma (HNSCC) without evidence of neck disease (crN0) is poorly defined. A retrospective review was carried out on 165 crN0 patients treated with salvage surgery and elective neck dissection. Multivariate Cox analysis and recursive partitioning analysis were used to evaluate prognostic factors. The frequency of occult neck node metastases in the neck dissection (rpN+) was 16.4%. The risk of occult metastases for glottic rpT1-T2 recurrences was 5.9%, for glottic rpT3-T4 recurrences 13.2%, for non-glottic rpT1-T2 recurrences 16.1% and for locally advanced (rpT3-T4) non-glottic recurrences 31.1%. Patients with occult neck node metastases (rpN+) had a 5-year adjusted survival rate of 38.1%, while patients without nodal disease (rpN0) had a 5-year adjusted survival rate of 71.1% (p = 0.0001). Elective neck dissection can be omitted in crN0 patients with rT1-T2 glottic recurrence. We consider it advisable to perform elective neck dissection in all other situations.

Svuotamento linfonodale cervicale elettivo nella chirurgia di salvataggio dopo radioterapia in pazienti con carcinoma a cellule squamose del distretto testa-collo.

Riassunto: Lo svuotamento linfonodale cervicale elettivo in pazienti con recidiva di carcinoma a cellule squamose del distretto testa-collo, senza evidenza clinico-radiologica di metastasi linfonodale (crN0), è scarsamente descritto in letteratura. Per questa ragione è stata condotta una revisione retrospettiva di una coorte di 165 pazienti crN0, sottoposti a chirurgia di salvataggio e svuotamento cervicale elettivo. Per la valutazione dei fattori prognostici sono state utilizzate l’analisi multivariata di Cox e l’analisi di partizione ricorsiva. Successivamente allo svuotamento cervicale, la frequenza di metastasi linfonodali occulte (rpN +) è stata del 16,4%. Il rischio di metastasi occulte, in caso di tumori glottici recidivanti, è stato del 5,9% per le categorie rpT1-T2, e del 13.2% per le categorie rpT3-T4. Per quanto riguarda i tumori non-glottici recidivanti, il rischio di metastasi occulte è stato del 16,1% per le categorie rpT1-T2, mentre in caso di neoplasie localmente avanzate (rpT3-T4) è stato del 31,1%. La sopravvivenza a 5anni dei pazienti con metastasi linfonodali occulte (rpN +) é stata del 38,1%, mentre la sopravvivenza a 5 anni dei pazienti che non hanno presentato invasione linfonodale (rpN0) è stata del 71,1% (con una differenza statisticamente significativa, p = 0,0001). Lo svuotamento cervicale potrebbe essere omesso in pazienti con neoplasia glottica recidiva crN0 rT1-T2. Al contrario, alla luce di questi risultati, riteniamo che sia consigliabile eseguire questa tecnica in tutte le altre situazioni.

Keywords: Elective neck dissection; Head and neck cancer; Occult neck node metastases; Salvage surgery.

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Figures

Fig. 1.
Fig. 1.
Classification obtained with the classification and regression tree method.
Fig. 2.
Fig. 2.
Adjusted survival of patients with HNSCC local recurrence according to the presence of occult neck node metastases.
See this image and copyright information in PMC

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