Regional recurrences of N0 primary laryngeal cancer: a retrospective study of fiveyear period.

Purpose: To analyse the stage of nodal neck recurrences when first encountered and to determine the relevance of selective lateral neck dissection by retrospective review of patients with regional recurrence.

Patients And Methods: The files of patients with nodal neck metastases were retrospectively reviewed, covering a 5-year period (1991-1995). Chosen were cases with only regional recurrences of N0 primaries confined to the larynx and initially treated solely with resection of the primary. Cases in which regional recurrences were accompanied by local recurrences were excluded. We took into account T stage of the primary tumor, time to recurrence, recurrence localization, N status, presence of extracapsular spread, and distant metastases.

Results: For the period studied 310 patients with N0 laryngeal primaries were found. Thirty-eight (12.25%) cases developed regional recurrences and were consistent with the listed criteria. At the time of initial treatment 2 (5.3%) patients were T1, 3 (7.9%) T2, 27 (71%) T3, and 6 (15.8%) T4. The median time to recurrence was 13.1 months. The N stage of the recurrences was as follows: 4 (10%) patients had N1, 11 (29%) N2a, 8 (21%) N2b, 3 (8%) N2c, and 12 (32%) N3. Extracapsular spread was identified in 17 (43%) cases.

Conclusion: In cases of advanced laryngeal carcinomas the wait-and-see policy is hazardous. In such cases it is advisable to perform simultaneous resection of the primary and elective neck dissection.