Rate of occult neck nodal metastasis in primary and salvage laryngectomy

The role of neck dissection (ND) in advanced laryngeal cancer remains controversial. Cervical nodal metastases confer a worse prognosis with higher rates of local recurrence and reduced overall survival observed in this population. Elective ND for clinically node negative (N0) patients during laryngectomy has been associated with reduced rates of regional recurrence; however, the addition of this surgical intervention introduces risk of complications including accessory nerve injury, wound healing issues and infection. Select European society guidelines, such as the German guidelines for treatment of laryngeal cancer, recommend ipsilateral ND for lateralised laryngeal malignancy and bilateral ND for midline lesions, while guidelines in the United Kingdom and the National Comprehensive Cancer Network (NCCN) in the United States offer more broad recommendations encompassing numerous surgical options. In salvage laryngectomy, the role of N0 elective ND remains equally ambiguous. The overall rate of occult metastasis following salvage laryngectomy with ND has been reported as 3%–19%. Many studies pre-date the development of advanced radiological investigations and therapeutic techniques. Recent attempts at meta-analysis found only three papers suitable for inclusion in pooled analysis.