Critical appraisal of watchful waiting policy in the management of N0 neck of advanced laryngeal carcinoma
A. P. Yuen, W. I. Wei and S. H. Wong
Department of Surgery, University of Hong Kong, Queen Mary Hospital.
OBJECTIVE: To analyze the problem of nodal recurrence of N0 neck advanced
laryngeal carcinoma. DESIGN: Retrospective analysis. SETTING: Hospital
referral center. PATIENTS: One hundred thirty-three patients with cancer
stages T3-T4, N0, M0 who had total laryngectomy between January 1981 and
December 1990. MAIN OUTCOME MEASURE: Nodal recurrence. RESULTS: Of the 11
patients who had elective radical neck dissections, there was no nodal
recurrence. Of the other 122 patients who had no elective neck dissection,
19 patients (16%) developed nodal recurrence and all nodal recurrence was
at levels II, III, and IV. Twelve patients (63%) underwent salvage radical
neck dissection for nodal recurrence and they had a 38% adjusted 5-year
actuarial survival rate. Of these 122 patients who had no elective neck
dissection for the N0 neck, 12 patients (10%) eventually died of nodal
recurrence. CONCLUSIONS: The watchful waiting policy is a satisfactory
management option of N0 neck of advanced laryngeal carcinoma.
