ELECTIVE NECK DISSECTION IN THE TREATMENT OF T3 T4 NO SQUAMOUS-CELL CARCINOMA OF THE LARYNX/

BACKGROUND: This study analyzed pathologic findings of clinically occu lt cervical lymph nodes of T3/T4 NO squamous cell laryngeal carcinoma and their impact on locoregional failures and overall survival. PATIEN TS AND METHODS: A retrospective analysis of 76 patients with T3/T4 NO laryngeal carcinoma was carried out between 1981 and 1989. Sixty-seven patients had transglottic tumor, 31 patients had extralaryngeal sprea d, 56 patients were T3 NO, and 20 patients were T4 NO. Seventy-five pa tients had total laryngectomy and 1 had near total laryngectomy. All p atients had bilateral elective neck dissection. The chi-square test wa s applied to factors related to neck metastasis and locoregional failu re. Survival was analyzed using the Kaplan-Meier actuarial method; dif ferences were tested using the Wilcoxon signed-rank test. RESULTS: Eig hteen patients had positive surgical margins. Occult neck metastasis w as observed in 30%. Univariate analysis showed that cancer stage and c artilage status were not significant to predict neck metastasis. Locor egional recurrence was observed in 28% of patients. Surgical margins, cervical metastasis, lesion extension, and cartilage invasion had sign ificant impact on disease-free survival. The 5-year overall survival w as 52%; disease-free survival was 57%. CONCLUSION: The elective bilate ral neck dissection performed in T3/T4 NO patients yielded a 30% incid ence of occult neck metastasis. Classification of transglottic carcino mas into endolaryngeal and exolaryngeal provides a better parameter fo r predicting neck metastasis than does T status. Disease-free and over all survival were significantly affected by neck metastasis, T stage, exolaryngeal tumor, cartilage infiltration, and surgical margins.