Management of the neck in cancer of the larynx

In the Department of Otolaryngology at the University of Pittsburgh School of Medicine, cancer of the larynx is usually treated by primary surgery. Ra diotherapy is used as adjuvant treatment in certain patients who have cance r that has adverse histologic features such as perineural, vascular, and/or cartilage invasion. With this approach, patients rarely develop local recu rrence. Patient survival is therefore unlikely to be improved by changes to the management of the primary tumor. Survival may, however, be improved by reducing the incidence of recurrence in the neck, as well as distant. Henc e, we have adapted an aggressive surgical approach to the cN+ as well as th e NO neck. The theoretical basis for this aggressive surgical approach to t he neck will be considered under the following headings: staging, regional control, distant metastasis, survival, choice of neck dissection, and the p athologically positive elective neck dissection.