ELECTIVE NECK DISSECTION IN THE TREATMENT OF T3/T4 NO SQUAMOUS-CELL CARCINOMA OF THE LARYNX

BACKGROUND: This study analyzed pathologic findings of clinically occult cervical lymph nodes of T3/T4 NO squamous cell laryngeal carcinoma and their impact on locoregional failures and overall survival. PATIENTS AND METHODS: A retrospective analysis of 76 patients with T3/T4 NO laryngeal carcinoma was carried out between 1981 and 1989. Sixty-seven patients had transglottic tumor, 31 patients had extralaryngeal spread, 56 patients were T3 NO, and 20 patients were T4 NO. Seventy-five patients had total laryngectomy and 1 had near total laryngectomy. All patients had bilateral elective neck dissection. The chi-square test was applied to factors related to neck metastasis and locoregional failure. Survival was analyzed using the Kaplan-Meier actuarial method; differences were tested using the Wilcoxon signed-rank test. RESULTS: Eighteen patients had positive surgical margins. Occult neck metastasis was observed in 30%. Univariate analysis showed that cancer stage and cartilage status were not significant to predict neck metastasis. Locoregional recurrence was observed in 28% of patients. Surgical margins, cervical metastasis, lesion extension, and cartilage invasion had significant impact on disease-free survival. The 5-year overall survival was 52%; disease-free survival was 57%. CONCLUSION: The elective bilateral neck dissection performed in T3/T4 NO patients yielded a 30% incidence of occult neck metastasis. Classification of transglottic carcinomas into endolaryngeal and exolaryngeal provides a better parameter for predicting neck metastasis than does T status. Disease-free and overall survival were significantly affected by neck metastasis, T stage, exolaryngeal tumor, cartilage infiltration, and surgical margins.