A Risk-Adapted Approach for Elective Neck Dissection in Salvage Total Laryngectomy: Revisiting the Role of Tumor Subsite and Occult Nodal Disease.

IF 2.2 3区医学 Q1 OTORHINOLARYNGOLOGY

Head and Neck-Journal for the Sciences and Specialties of the Head and Neck Pub Date : 2025-10-13 DOI:10.1002/hed.70072

Chiesa-Estomba Carlos M, Melkane Antoine, Dequanter Didier, Brunet Aina, Maniaci Antonino, Karra Khawla, Jerome R Lechien, Droppelman-Alvarez Paulina, Roldan-Fidalgo Amaya, Palacios Jose, Baguda Eva, Ayad Tareck

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引用次数: 0

Abstract

Background: The role of elective neck dissection (END) during salvage total laryngectomy (STL) in clinically node-negative (cN0) patients remains controversial due to variable risks of occult nodal metastasis and surgical morbidity.

Methods: We conducted a multicenter retrospective study of 178 cN0 patients undergoing STL after radiotherapy (RT) or chemoradiotherapy (CRT). Rates of occult nodal disease, survival outcomes, and predictive factors were analyzed.

Results: Occult nodal metastases were found in 19.7% of cases, highest in hypopharyngeal (35.7%) and supraglottic (24.5%) tumors. Tumor subsite and lymphovascular invasion were independent predictors of nodal positivity, while prior chemotherapy reduced risk. Patients with occult nodal disease had significantly worse three-year overall and disease-specific survival.

Conclusions: A risk-adapted approach to END in STL is recommended, particularly for supraglottic and hypopharyngeal tumors. Routine END may be unnecessary in low-risk subsites like glottic tumors. Prospective studies are needed to refine management strategies.

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挽救性全喉切除术中择期颈部清扫的风险适应方法：重新审视肿瘤亚位和隐匿淋巴结疾病的作用。

背景：在临床淋巴结阴性（cN0）患者的补救性全喉切除术（STL）中，选择性颈部清扫（END）的作用仍然存在争议，因为隐性淋巴结转移和手术发病率的风险不同。方法：我们对178例放疗或放化疗后STL的cN0患者进行了多中心回顾性研究。分析隐匿性淋巴结病的发生率、生存结局和预测因素。结果：隐匿淋巴结转移率为19.7%，以下咽肿瘤（35.7%）和声门上肿瘤（24.5%）最高。肿瘤亚位和淋巴血管浸润是淋巴结阳性的独立预测因素，而先前的化疗可降低风险。隐匿性淋巴结疾病患者的三年总生存率和疾病特异性生存率明显较差。结论：推荐采用风险适应的STL终末治疗方法，特别是对于声门上和下咽肿瘤。对于像声门肿瘤这样的低风险亚位点，常规的END可能是不必要的。需要前瞻性研究来完善管理策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Head and Neck-Journal for the Sciences and Specialties of the Head and Neck 医学-耳鼻喉科学

CiteScore

7.00

自引率

6.90%

发文量

278

审稿时长

1.6 months

期刊介绍： Head & Neck is an international multidisciplinary publication of original contributions concerning the diagnosis and management of diseases of the head and neck. This area involves the overlapping interests and expertise of several surgical and medical specialties, including general surgery, neurosurgery, otolaryngology, plastic surgery, oral surgery, dermatology, ophthalmology, pathology, radiotherapy, medical oncology, and the corresponding basic sciences.