Abstract：
The role of elective neck dissection during salvage surgery in patients with a clinically negative neck (cN0) is still discussed. The main objective of this work was to estimate the prevalence and predictive factors of occult neck nodes metastasis; we therefore aimed to evaluate the survival rate and the main oncologic outcomes of cN0 patients who underwent salvage total laryngectomy and elective bilateral neck dissection. In this retrospective observational study, we enrolled 80 cN0 patients affected by recurrent laryngeal cancer and who underwent salvage total laryngectomy and bilateral selective elective neck dissection. Several parameters were collected in order to find prognostic factors; finally, postoperative complications were reviewed and survival analysis was performed. Occult lymph node metastases were reported in 18 out of 80 patients (22.5%). Significant statistical correlation between lymphovascular invasion (p = 0.007), perineural invasion (p = 0.025) and occult nodal metastasis was found. Other variables (glottic subsite of recurrence, clinical T, pathological T, previous chemotherapy) were not significantly predictive of occult nodal metastasis. The 5-year OS, DSS, and RFS were 50.4%, 64.7%, and 63.4%, respectively. In conclusion, our single-institution data on a large cohort of patients, suggest performing routinely elective selective bilateral neck dissection during salvage total laryngectomy in cN0 patients due to the biological attitude of the tumor to spread to cervical nodes, considering an acceptable complications rate.
摘要：
仍在讨论临床颈部阴性（cN0）的患者在抢救手术中进行选择性颈清扫术的作用。这项工作的主要目的是评估隐匿性颈淋巴结转移的患病率和预测因素；因此，我们旨在评估接受挽救性全喉切除术和选择性双侧颈淋巴结清扫术的cN0患者的生存率和主要肿瘤学结果。在这项回顾性观察研究中，我们纳入了80例受喉癌复发影响的cN0患者,这些患者接受了挽救性全喉切除术和双侧选择性选择性颈淋巴结清扫术.为了找到预后因素，收集了几个参数；最后，回顾术后并发症并进行生存分析.80例患者中有18例（22.5％）报告了隐匿性淋巴结转移。淋巴管浸润之间的显着统计相关性（p=0.007），发现神经周浸润（p=0.025）和隐匿性淋巴结转移。其他变量（复发的声门亚位点，临床T，病理性T，以前的化疗）不能显着预测隐匿性淋巴结转移。5年OS,DSS,RFS为50.4%，64.7%,和63.4%，分别。总之,我们单一机构的大量患者数据，由于肿瘤扩散到颈淋巴结的生物学态度，建议在cN0患者的挽救性全喉切除术期间进行常规选择性双侧颈清扫术，考虑可接受的并发症率。
