Introduction: Locoregional recurrence after salvage laryngectomy for squamous cell carcinoma (SCC) is a challenging problem. Identifying pathologic and surgical factors that predict locoregional recurrence may allow for optimization of surgical planning and risk stratification to guide adjuvant therapy. In particular, the benefit of paratracheal node dissection during salvage laryngectomy remains controversial. Previously, we established that recurrent glottic SCC undergoing salvage laryngectomy has a high occult rate of positivity in the paratracheal basin, particularly in advanced stages. Thus we sought to evaluate whether paratracheal node dissection had any effect on locoregional disease free survival (DFS) and disease specific survival (DSS).
Methods: A single-institution retrospective case series was performed of patients who underwent salvage laryngectomy between 1998 and 2015 for recurrent or persistent disease after radiation or chemoradiation (n = 237). Clinical, surgical and pathologic data was collected. Statistical analysis, including chi-square and Kaplan-Meier testing, was performed.
Results: 58 patients recurred locoregionally (24%) in our cohort. Advanced stage (T4 or N+ disease) was significantly associated with locoregional recurrence (p = 0.001). Further investigating specifically at advanced stage glottic SCCs (stage IV; n = 46), paratracheal node dissection was associated with significantly improved 5-year DFS (68% vs. 31%; p = 0.03), locoregional DFS (74% vs. 39%; p = 0.02), and DSS (65% vs. 32%; 0.03). Notably, there was no difference in distant DFS (p = 0.17).
Conclusions: Patients with advanced stage recurrent glottic SCCs undergoing salvage laryngectomy have a high rate of occult paratracheal nodal disease. Paratracheal nodal dissection at the time of surgery may confer a locoregional disease free survival and disease specific survival benefit in these patients. Further investigation in additional cohorts will be valuable to validate this finding.