Neck dissection for advanced laryngeal cancer: Role and relevance in KwaZulu-Natal Province, South Africa
DOI:
https://doi.org/10.7196/Keywords:
neck dissection, occult metastasis, clinically N0 necks, substance useAbstract
Background. The global standard of care for advanced laryngeal squamous cell carcinoma (SCC) is total laryngectomy and neck dissection. While this approach aligns with international guidelines, there is no consensus on whether elective neck dissection (END) should be incorporated during primary surgery for clinically negative neck nodes (cN0) or as a therapeutic option after nodal relapse. It is therefore imperative to evaluate associated oncological outcomes and local contextual factors regarding END surgical approach in advanced laryngeal SCC.
Objective. To evaluate the lymph node outcomes and the rate of occult metastases (OM) of patients with advanced laryngeal cancer who underwent total laryngectomy with neck dissection.
Methods. A retrospective chart review was conducted at a South African hospital. Clinical records of 113 patients with stage III/IV laryngeal cancer who underwent total laryngectomy were retrieved from the hospital’s health information system for analysis. Demographic data, postoperative care, and clinical and pathological reports were analysed.
Results. The patients were predominantly male (92.6%), of African origin (62%), with a mean age of 61.0 years and HIV seroposivity rate of 13.2%. Combined alcohol and tobacco use prevalence was 58.4%, while that of tobacco use alone was 31%. Overall histopathological tumour analyses showed that 74.3% had clear margins, 16.8% close margins and 8.0% positive margins. A total of 71.7% of the patients were initially classified as cN0, before histopathological results revealed 30.9% to have OM, with 3.75% having extranodal involvement. Substance use in the cN0 group with OM, regardless of HIV serostatus, was strongly associated with OM.
Conclusion. This study supports the importance of END in advanced laryngeal SCC and cN0 patients, aligning with global OM rates. These findings provide critical insights into the local context, supporting the continuation of END as standard of care in our institution.
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