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Elective Paratracheal Lymph Node Dissection in Salvage Laryngectomy.
Farlow, Janice L; Birkeland, Andrew C; Rosko, Andrew J; VanKoevering, Kyle; Haring, Catherine T; Smith, Joshua D; Brenner, J Chad; Shuman, Andrew G; Chinn, Steven B; Stucken, Chaz L; Malloy, Kelly M; Moyer, Jeffrey S; Casper, Keith A; McLean, Scott A; Prince, Mark E P; Bradford, Carol R; Wolf, Gregory T; Chepeha, Douglas B; Spector, Matthew E.
Affiliation
  • Farlow JL; Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.
  • Birkeland AC; Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, CA, USA.
  • Rosko AJ; Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.
  • VanKoevering K; Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.
  • Haring CT; Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.
  • Smith JD; Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.
  • Brenner JC; Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.
  • Shuman AG; Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.
  • Chinn SB; Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.
  • Stucken CL; Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.
  • Malloy KM; Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.
  • Moyer JS; Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.
  • Casper KA; Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.
  • McLean SA; Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.
  • Prince MEP; Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.
  • Bradford CR; Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.
  • Wolf GT; Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.
  • Chepeha DB; Department of Otolaryngology, University of Toronto, Toronto, ON, Canada.
  • Spector ME; Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA. mspector@med.umich.edu.
Ann Surg Oncol ; 26(8): 2542-2548, 2019 Aug.
Article in En | MEDLINE | ID: mdl-30830535
ABSTRACT

BACKGROUND:

Indications for and efficacy of paratracheal nodal dissection (PTND) in patients undergoing laryngectomy (salvage) for persistent or recurrent laryngeal squamous cell carcinoma are not well-defined.

METHODS:

A retrospective cohort study was performed for patients undergoing salvage laryngectomy with clinically and radiographically negative neck disease between 1998 and 2015 (n = 210). Univariate and multivariate Cox regression analyses were performed.

RESULTS:

PTND was performed on 77/210 patients (36%). The PTND cohort had a greater proportion of advanced T classification (rT3/rT4) tumors (78%) than subjects without PTND (55%; p = 0.001). There was a 14% rate of occult nodal metastases in the paratracheal basin; of these, 55% did not have pathologic lateral neck disease. Multivariate analysis controlling for tumor site, tumor stage, and pathologic lateral neck disease demonstrated that PTND was associated with improved overall survival [OS] (p = 0.03; hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.38-0.96), disease-free survival [DFS] (p = 0.03; HR 0.55, 95% CI 0.31-0.96), and distant DFS survival (p = 0.01; HR 0.29, 95% CI 0.11-0.77). The rate of hypocalcemia did not differ between subjects who underwent bilateral PTND, unilateral PTND, or no PTND (p = 0.19 at discharge, p = 0.17 at last follow-up).

CONCLUSIONS:

PTND at the time of salvage laryngectomy was more common in patients with rT3/rT4 tumors and was associated with improved OS and DFS, with no effect on hypocalcemia. In patients undergoing PTND, the finding of occult paratracheal metastases was often independent of lateral neck metastases.
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Full text: 1 Database: MEDLINE Main subject: Tracheal Neoplasms / Laryngeal Neoplasms / Salvage Therapy / Elective Surgical Procedures / Laryngectomy / Lymph Node Excision / Lymph Nodes Type of study: Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Female / Humans / Male / Middle aged Language: En Year: 2019 Type: Article
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Full text: 1 Database: MEDLINE Main subject: Tracheal Neoplasms / Laryngeal Neoplasms / Salvage Therapy / Elective Surgical Procedures / Laryngectomy / Lymph Node Excision / Lymph Nodes Type of study: Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Female / Humans / Male / Middle aged Language: En Year: 2019 Type: Article