Elective neck dissection for salvage laryngectomy: A systematic review and meta-analysis. (September 2019) - Lin, Chen
Highlights: Salvage laryngectomy is often indicated for locally recurrent laryngeal squamous cell carcinoma. Elective neck dissection (END) is debated in cases without evidence of regional metastasis. Our meta-analysis found overall rate of occult nodal metastasis is 14%. Highest rates of occult nodal metastasis are supraglottic (24%) and recurrent T3/4 tumors (21%). Abstract: Objective: Elective neck dissection (END) for salvage laryngectomy remains controversial due to variability in reported occult nodal metastasis rates and postoperative complications. We performed a meta-analysis to examine the role of END for treatment of the clinically N0 (cN0) neck in the salvage setting. Methods: A PubMed search, without limit on years searched, was conducted for English language articles. Additional sources were found by reviewing bibliographies of pertinent articles. Studies had to include END data for salvage laryngectomy for locally recurrent squamous cell carcinoma of the larynx with clinically negative regional metastasis. For patients who underwent END, pathological node status had to be reported. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendations were followed. Data were pooled using a random-effects model. Results: Nineteen studies were included in the analysis. Within the END group, 31% were supraglottic, 61% were glottic, 6% were transglottic, and 1% were subglottic. The pooled rate of occult nodal metastasis was 14% (95% CI = 0.11–0.17) for all subsites. In subsite-specific analyses, occult nodal metastasis rates were 24% for supraglottic, 9% for glottic, and 17% for transglottic recurrences. Occult nodal metastasis was higher in recurrent T3/4 tumors (21%) compared to recurrent T1/2 tumors (9%) (relative risk (RR) = 2.17, 95% CI = 1.23–3.63, p = 0.003). The RR of postoperative complications with END compared to observation was 1.72 (95% CI = 0.96–3.10, p = 0.07). Conclusions: The highest rates of occult nodal metastasis are associated with supraglottic recurrence and recurrent T3/T4 tumors. These data should be considered when deciding whether to perform END for salvage laryngectomy.