MANAGEMENT OF CERVICAL METASTASES IN SUPRAGLOTTIC CANCER

A retrospective review of patients from 1979 to 1988 was performed to assess the efficacy of neck dissection, prognostic factors, and the ph ilosophy of treatment of the neck in supraglottic cancer. Of the 89 pa tients available for analysis, 26 were managed by horizontal partial l aryngectomy (HPL), 44 by primary radiotherapy (RT), and 19 by total la ryngectomy (TL). A total of 41 patients from the group had 63 neck dis sections (NDs); 22 had bilateral and 19 unilateral dissections. A corr elation of the pN with N staging revealed that when presenting with N2 a nodes (>3 cm), one third had contralateral metastases, and with N2b (multiple), 100% had contralateral metastases. In multivariate analysi s of the disease-free interval, age and staging emerged as independent prognostic variables. Although we observed no increased morbidity by dissecting the opposite side, our results did not support routine bila teral neck dissection in NO patients. However, when the nodes are larg er than 3 cm, or ipsilateral and multiple, bilateral neck dissection i s recommended.