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. 2020 May;277(5):1481-1489.
doi: 10.1007/s00405-020-05838-7. Epub 2020 Feb 11.

Surgical nodal management in hypopharyngeal and laryngeal cancer

M C Ketterer  1 , L A Lemus Moraga  2 , U Beitinger  2 , J Pfeiffer  2 , A Knopf  2 , C Becker  2
Affiliations

Surgical nodal management in hypopharyngeal and laryngeal cancer

M C Ketterer et al. Eur Arch Otorhinolaryngol. 2020 May.

Abstract

Objective: The aim of this study is to compare pre-therapeutic staging of the loco-regional lymphatic basin and subsequent surgical management in cN0 versus cN+ hypopharyngeal and laryngeal cancer patients.

Methods: We analyzed all hypopharyngeal and laryngeal carcinoma patients treated surgically at a single quaternary medical care and cancer center between 2004 and 2014. We established two groups for patients who underwent neck dissection comparing patients with a low LNR (lymph node ratio) to one with a high LNR. Regarding the cN0 cohort, elective neck dissection was evaluated as a secondary predictor variable. Comorbidities, such as anemia and renal insufficiency, were analyzed as potentially influencing disease-free (DFS) and overall survival (OS).

Results: A total of 310 patients (185 glottic and 125 supraglottic/hypopharyngeal carcinoma) were included. Pre-therapeutic neck MRI-/CT-scan and concomitant neck ultrasound revealed cN+ status in 144 patients resulting in a significant over-staging in 63 patients (44%) who were rated as being pN0 after histological examination. 166 patients were staged cN0 and 21 underwent elective neck dissection (11 local advanced glottic and 10 supraglottic/hypopharyngeal carcinoma). Two cN0 patients showed occult cervical lymph node metastases (10%). Furthermore, we could detect a significant negative impact of the LNR divided by the number of dissected lymph nodes and OS.

Conclusion: The pre-therapeutic clinical evaluation of lymphatic outgrowth is over-staged. OS decreases with increasing LNR divided by the number of dissected lymph nodes. Renal insufficiency and anemia are significant negative factors, decreasing both OS and DFS.

Keywords: Elective neck dissection; Head and neck cancer; Hypopharyngeal carcinoma; Laryngeal carcinoma; Overall survival; cN0.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Study cohort
Fig. 2
Fig. 2
Overall survival for glottis cN0 laryngeal cancer patients regarding initial T- status (p < 0.0001)
Fig. 3
Fig. 3
Overall survival for hypopharyngeal and laryngeal cancer patients regarding initial creatinine level (p = 0.03)
Fig. 4
Fig. 4
Overall survival for hypopharyngeal and laryngeal cancer patients regarding initial anemia status (p = 0.01)
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