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Head and Neck Surgery

(344) Occult Neck Metastasis In Salvage laryngectomy

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • Ahmed Sobhy Youssef, MD, Phd, FRCS

    Fellow
    University of Oklahoma Health Sciences Center
    Alexandria, Al Iskandariyah, Egypt

    • Senior Author(s)

  • GK

    Greg Krempl, MD,FACS

    University Of Oklahoma Health Science Center
    Oklahoma city, OK, USA

    • Co-Author(s)

  • RP

    Rusha Patel, MD

    Associate Professor
    University of Oklahoma Health Sciences Center
    Oklahoma City, Oklahoma, United States

  • RM

    Rachad Mhawej, MD

    Assistant Professor
    University of Oklahoma Health Sciences Center
    Oklahoma City, Oklahoma, United States

Disclosure(s):
Ahmed Sobhy Youssef, MD, Phd, FRCS: No relevant relationships to disclose.
Rusha Patel, MD: No relevant relationships to disclose.
Rachad Mhawej, MD: No relevant relationships to disclose.


Introduction: For patients presented with locally recurrent/residual squamous cell carcinoma of the larynx, there is debate over the role of elective neck dissection (END) for clinically and radiologically negative nodal metastasis defined as N0 neck.Some surgeons do believe that neck dissection is a must considering that as standard care for those patients, others do not favor that with respect to potential morbidity in irradiated neck. None of these helped to answer another important question regarding contralateral neck or possible value of super selective neck dissection in those patients.

Methods: It is a retrospective study ,over a time frame of 6 years(2016-2022), for patients who underwent bilateral neck dissection and salvage laryngectomy for recurrent or persistent disease without prior clinical or radiological evidence of positive cervical lymph nodes, classified as N0 neck.Our primary objective was to study the incidence of contralateral neck disease in these patients.Our secondary objective was to calculate incidence of ipsilateral neck disease with respect to lymph node levels to check feasibility of super-selective neck dissection in salvage laryngectomy.

Results: 74 patients underwent salvage laryngectomy and bilateral neck dissection over period from 2016-2022.Incidence of ipsilateral neck disease was calculated as 8.11%.Incidence of contralateral neck nodal metastasis was 0%.Regarding ipsilateral nodal level distribution,Level II was the highest calculated as 6.76, followed by level III calculated as 5.41%.Level IV showed 0% metastasis as well as Level IIb.

Conclusions: In patients undergoing salvage laryngectomy with preoperative N0 neck, ipsilateral super selective neck dissection could be considered to maximize chances of cure with less operative time and less morbidity related to unnecessary dissection of level IIB, level IV and contralateral neck.