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Elective Paratracheal Lymph Node Dissection in Salvage Laryngectomy

Janice L. Farlow MD, PhD, Andrew C. Birkeland MD, Andrew J. Rosko MD, Kyle VanKoevering MD, Catherine T. Haring MD, Joshua D. Smith BA, J. Chad Brenner PhD, Andrew G. Shuman MD, Steven B. Chinn MD, MPH, Chaz L. Stucken MD, Kelly M. Malloy MD, Jeffrey S. Moyer MD, Keith A. Casper MD, Scott A. McLean MD, PhD, Mark E. P. Prince MD, Carol R. Bradford MD, Gregory T. Wolf MD, Douglas B. Chepeha MD, MScP
Head and Neck Oncology
Volume 26, Issue 8 / August , 2019

Abstract

Background

Indications for and efficacy of paratracheal nodal dissection (PTND) in patients undergoing laryngectomy (salvage) for persistent or recurrent laryngeal squamous cell carcinoma are not well-defined.

Methods

A retrospective cohort study was performed for patients undergoing salvage laryngectomy with clinically and radiographically negative neck disease between 1998 and 2015 (n = 210). Univariate and multivariate Cox regression analyses were performed.

Results

PTND was performed on 77/210 patients (36%). The PTND cohort had a greater proportion of advanced T classification (rT3/rT4) tumors (78%) than subjects without PTND (55%; p = 0.001). There was a 14% rate of occult nodal metastases in the paratracheal basin; of these, 55% did not have pathologic lateral neck disease. Multivariate analysis controlling for tumor site, tumor stage, and pathologic lateral neck disease demonstrated that PTND was associated with improved overall survival [OS] (p = 0.03; hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.38–0.96), disease-free survival [DFS] (p = 0.03; HR 0.55, 95% CI 0.31–0.96), and distant DFS survival (p = 0.01; HR 0.29, 95% CI 0.11–0.77). The rate of hypocalcemia did not differ between subjects who underwent bilateral PTND, unilateral PTND, or no PTND (p = 0.19 at discharge, p = 0.17 at last follow-up).

Conclusions

PTND at the time of salvage laryngectomy was more common in patients with rT3/rT4 tumors and was associated with improved OS and DFS, with no effect on hypocalcemia. In patients undergoing PTND, the finding of occult paratracheal metastases was often independent of lateral neck metastases.

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