End results of a prospective trial on elective lateral neck dissection vs type III modified radical neck dissection in the management of supraglotticand transglottic carcinomas

Background. Either-modified type III radical neck dissection (MRND) or late ral neck dissections (LNDs) are considered valid treatments for patients wi th laryngeal carcinoma with clinically negative neck findings (NO). The obj ect of this prospective study was to compare complications, neck recurrence s, and survival results of elective MRND and LND on the management of laryn geal cancer patients. Patients and Methods. This prospective randomized study began in 1990, and patient accrual was closed on December 1993. A total of 132 patients was in cluded in the trial. All patients had previously untreated T2-T4 NO MO supr aglottic or transglottic squamous cell carcinoma. No significant imbalance was found between groups with respect to demographic, clinical, pathologic, and other therapeutic variables. Seventy-one patients were given MRNDs (13 bilateral) and 61 were given LNDs (18 bilateral). Results. The false-negative rate was 26%, and most positive nodes were site d at levels II and III. Complications and period of hospitalization were si milar in both groups. There were 6 ipsilateral neck recurrences (4 in the M RND group, and 2 in the LND group). The 5-year actuarial survival calculate d by Kaplan-Meier method was 72.3% in the MRND group and 62.4% in the LND g roup (log-rank test p = .312). Conclusions. The rate of false-negative nodes in supraglottic and transglot tic carcinomas was 26%, and most positive nodes were at levels II and III. The rates of 5-year overall survival, neck recurrences, and complications w ere similar in both groups. These results confirm the efficacy of lateral n eck dissection in the elective treatment of the neck in patients with supra glottic and transglottic carcinomas. (C) 1999 John Wiley & Sons, Inc. Head Neck 21: 694-702, 1999.