There has recently been a move away from elective neck dissections in the setting of salvage laryngectomy. This has mainly resulted from an appreciation of the increase in morbidity, in particular pharyngocutaneous fistula formation, and an improvement in cross-sectional imaging that has theoretically reduced the incidence of occult disease. This study set out to quantify the rate of occult neck metastasis in salvage laryngectomy patients and to also look at predictors of occult neck metastases and if more extensive surgery led to greater morbidity and complications. This was a retrospective study looking at 59 patients who underwent salvage laryngectomy at a single institution.
Eleven percent (five out of 45) of patients with no evidence of neck metastases prior to surgery had pathological evidence of nodal neck metastases after surgery. None of these occult metastases were on the contralateral side. There was no association between the extent of neck dissection and fistula formation.
There was also no difference in fistula formation with pharyngeal reconstruction. This may be because reconstruction was only used in patients with significant comorbidities, although this was not elaborated in the paper. Unfortunately, the low number of patients in the study is a significant drawback.