Rational surgical neck management in total laryngectomy for advanced stage laryngeal squamous cell carcinomas
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Rational surgical neck management in total laryngectomy for advanced stage laryngeal squamous cell carcinomas. / Böttcher, Arne; Betz, Christian Stephan; Bartels, Stefan; Schönnagel, Björn; Münscher, Adrian; Bußmann, Lara; Busch, Chia-Jung; Knopke, Steffen; Bibiza-Freiwald, Eric; Möckelmann, Nikolaus.
in: J CANCER RES CLIN, Jahrgang 147, Nr. 2, 02.2021, S. 549-559.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Rational surgical neck management in total laryngectomy for advanced stage laryngeal squamous cell carcinomas
AU - Böttcher, Arne
AU - Betz, Christian Stephan
AU - Bartels, Stefan
AU - Schönnagel, Björn
AU - Münscher, Adrian
AU - Bußmann, Lara
AU - Busch, Chia-Jung
AU - Knopke, Steffen
AU - Bibiza-Freiwald, Eric
AU - Möckelmann, Nikolaus
PY - 2021/2
Y1 - 2021/2
N2 - PURPOSE: Controversies exist in regard to surgical neck management in total laryngectomies (TL). International guidelines do not sufficiently discriminate neck sides and sublevels, or minimal neck-dissection nodal yield (NY).METHODS: Thirty-seven consecutive primary TL cases from 2009 to 2019 were retrospectively analyzed in terms of local tumor growth using a previously established imaging scheme, metastatic neck involvement, and NY impact on survival.RESULTS: There was no case of level IIB involvement on any side. For type A and B tumor midline involvement, no positive contralateral lymph nodes were found. Craniocaudal tumor extension correlated with contralateral neck involvement (OR: 1.098, p = 0.0493) and showed increased involvement when extending 33 mm (p = 0.0134). Using a bilateral NY of ≥ 24 for 5-year overall survival (OS) and ≥ 26 for 5-year disease-free survival (DFS) gave significantly increased rate advantages of 64 and 56%, respectively (both p < 0.0001).CONCLUSIONS: This work sheds light on regional metastatic distribution pattern and its influence on TL cases. An NY of n ≥ 26 can be considered a desirable benchmark for bilateral selective neck dissections as it leads to improved OS and DFS. Therefore, an omission of distinct neck levels cannot be promoted at this time.
AB - PURPOSE: Controversies exist in regard to surgical neck management in total laryngectomies (TL). International guidelines do not sufficiently discriminate neck sides and sublevels, or minimal neck-dissection nodal yield (NY).METHODS: Thirty-seven consecutive primary TL cases from 2009 to 2019 were retrospectively analyzed in terms of local tumor growth using a previously established imaging scheme, metastatic neck involvement, and NY impact on survival.RESULTS: There was no case of level IIB involvement on any side. For type A and B tumor midline involvement, no positive contralateral lymph nodes were found. Craniocaudal tumor extension correlated with contralateral neck involvement (OR: 1.098, p = 0.0493) and showed increased involvement when extending 33 mm (p = 0.0134). Using a bilateral NY of ≥ 24 for 5-year overall survival (OS) and ≥ 26 for 5-year disease-free survival (DFS) gave significantly increased rate advantages of 64 and 56%, respectively (both p < 0.0001).CONCLUSIONS: This work sheds light on regional metastatic distribution pattern and its influence on TL cases. An NY of n ≥ 26 can be considered a desirable benchmark for bilateral selective neck dissections as it leads to improved OS and DFS. Therefore, an omission of distinct neck levels cannot be promoted at this time.
U2 - DOI: 10.1007/s00432-020-03352-1
DO - DOI: 10.1007/s00432-020-03352-1
M3 - SCORING: Journal article
VL - 147
SP - 549
EP - 559
JO - J CANCER RES CLIN
JF - J CANCER RES CLIN
SN - 0171-5216
IS - 2
ER -
