TREATMENT OF THE CLINICALLY NEGATIVE NECK IN LARYNGEAL-CANCER PATIENTS

Background. Elective treatment of the ND neck in patients with larynge al cancer remains a controversial issue. We reviewed our experience wi th patients who had neck dissection for NO laryngeal carcinoma with oc cult metastases in order to compare elective lymphadenectomy results w ith those achieved with therapeutic neck dissection performed subseque ntly when occult disease became clinically evident. Methods. We retros pectively analyzed 150 N0 laryngeal cancer patients who after a neck d issection had histologically positive lymph nodes and 5-year minimum f ollow-up. This population was divided in two subsets, including: 54 N0 patients with occult neck metastases who had an elective neck surgery (ED); 96 initially ND patients who had a subsequent therapeutic neck dissection when nodal involvement became clinically detectable (STD). The two groups were compared with respect to the pattern of nodal meta stasis and sites of treatment failures and also in terms of absolute, determinate, and actuarial survival. Results. Overall absolute surviva l was 72.2% in the elective dissected (ED) group, compared with 54.1% in the group of subsequent therapeutic dissected (STD) patients (p = 0 .075). Determinate survival was 74.0% after ED and 59.3% after STD (p = 0.17). Actuarial curves by the Kaplan-Meier method did not show any statistically significant differences among the two groups analyzed (l ogrank test, p = 0.54). Accordingly, Cox multivariate analysis confirm ed that neck treatment policy had no prognostic impact on survival in our NO laryngeal cancer patients. However, a higher proportion of STD patients died of metastases at distant sites compared with ED patients (21.9% vs 7.4%, respectively) (p = 0.02). Conclusions. Elective lymph adenectomy does not significantly improve survival in NO laryngeal can cer patients with occult disease compared with those undergoing a ther apeutic neck dissection when metastases subsequently appear. (C) 1996 John Wiley & Sons, Inc.