Our Summary

This research was aimed at understanding how often hidden or “occult” cancerous nodes were found in patients who went through a specific type of surgery (elective neck dissection, or END) during a procedure to remove their larynx (voice box) after initial chemotherapy and radiation treatment failed (a process known as salvage laryngectomy). The study also compared survival rates and complications after surgery between patients who went through END and those who were just observed.

Going through 18 separate studies involving over a thousand patients, researchers found that about 11% of the patients who had the END procedure during their larynx removal surgery had these hidden cancerous nodes.

The research also looked at 5-year survival rates for some of the patients and found no significant difference in survival whether patients had the END procedure or were just observed. Similarly, the risk of developing a hole or abnormal connection in the body (known as a fistula) wasn’t significantly different between the two groups of patients.

However, because the studies they looked at varied a lot and didn’t have enough data, they couldn’t include most patients in the overall analysis of the outcomes.

So, in simple terms, for patients having their voice box removed after initial cancer treatment didn’t work, having an additional procedure to look for hidden cancerous nodes found these nodes in about 11% of cases. But whether or not they had this additional procedure didn’t seem to significantly affect their survival chances or risk of complications.

FAQs

  1. What is the rate of occult cervical nodal metastasis in patients undergoing elective neck dissection during salvage laryngectomy?
  2. Is there a significant difference in survival and postoperative complication rates between patients undergoing elective neck dissection versus observation?
  3. What is the risk of fistula formation in patients undergoing elective neck dissection during salvage laryngectomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about laryngectomy is to follow a careful and thorough post-operative care plan to prevent complications such as fistula formation. This may include instructions on wound care, diet modifications, voice rehabilitation exercises, and regular follow-up appointments. It is important to communicate any concerns or symptoms to your healthcare provider promptly to ensure proper healing and recovery.

Suitable For

Patients who are typically recommended for laryngectomy include those with advanced laryngeal cancer that has not responded to other treatments such as radiation or chemotherapy. Additionally, patients with recurrent laryngeal cancer or those who have developed complications such as airway obstruction may also be candidates for laryngectomy. In some cases, patients with laryngeal cancer that has spread to the lymph nodes in the neck may also undergo laryngectomy in order to remove the affected lymph nodes.

Timeline

Before laryngectomy:

  1. Patient is diagnosed with laryngeal cancer and undergoes primary chemoradiation therapy.
  2. Patient may experience symptoms such as hoarseness, difficulty swallowing, and a persistent cough.
  3. Imaging studies and biopsies may be performed to determine the extent of the cancer.
  4. Decision is made to proceed with salvage laryngectomy, potentially with elective neck dissection.

After laryngectomy:

  1. Patient undergoes salvage laryngectomy with or without elective neck dissection.
  2. Pathology results reveal the presence or absence of occult cervical nodal metastasis.
  3. Patient may experience postoperative complications such as fistula formation.
  4. Patient undergoes follow-up care and monitoring for recurrence.
  5. Meta-analysis shows no significant difference in overall survival or complication rates between patients who underwent elective neck dissection versus observation.

What to Ask Your Doctor

  1. What is the purpose of elective neck dissection (END) during salvage laryngectomy?
  2. What is the likelihood of finding occult cervical nodal metastasis during END?
  3. How does undergoing END during salvage laryngectomy affect overall survival compared to observation?
  4. What are the potential complications associated with END during salvage laryngectomy?
  5. Are there any specific criteria or factors that determine whether a patient should undergo END during salvage laryngectomy?
  6. How will END during salvage laryngectomy impact my postoperative recovery and quality of life?
  7. What are the potential long-term implications of undergoing END during salvage laryngectomy?
  8. Are there any alternative treatment options or approaches that could be considered instead of END?
  9. How often will I need follow-up monitoring or surveillance after undergoing salvage laryngectomy with or without END?
  10. Are there any additional resources or support services available for patients undergoing salvage laryngectomy with END?

Reference

Authors: Gross JH, Vila PM, Simon L, Rizvi ZH, Zenga J, Jackson RS, Pipkorn P. Journal: Laryngoscope. 2020 Apr;130(4):899-906. doi: 10.1002/lary.28323. Epub 2019 Oct 8. PMID: 31593291