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Video

Head and Neck Surgery

(A626) Role of Elective Neck Dissection in Salvage Laryngectomy

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters

    Presenting Author(s)

  • Ryan T. Judd, MD

    Resident
    Ohio State University Hospital Program
    Columbus, Ohio, United States

    • Co-Author(s)

  • DB

    Dukagjin Blakaj, MD PhD

    The Ohio State University, United States

  • AA

    Amit Agrawal, MD

    Professor
    Ohio State University Hospital, Department of Otolaryngology - Head and Neck Surgery
    Columbus, OH, United States

  • EO

    Enver Ozer, MD

    Professor
    Ohio State Univ Med Ctr; OTO
    Columbus, OH, United States

  • RC

    Ricardo L. Carrau, MD MBA

    Professor
    The Ohio State University Wexner Medical Center
    columbus, Ohio, United States

  • TT

    Theodoros Teknos, MD

    University Hospitals Seidman Cancer Center, United States

  • Kyle K. VanKoevering, MD

    Associate Professor in the College of Medicine
    The Ohio State University Wexner Medical Center
    Columbus, Ohio, United States

  • James W. Rocco, MD, PhD

    Chair of Otolaryngology-HNS
    The OSU Wexner Medical Center
    Columbus, OH, United States

  • MO

    Matthew O. Old, MD

    Professor and Director, Otolaryngology Head and Neck Surgery
    The Ohio State University Wexner Medical Center
    Columbus, Ohio, United States

  • Nolan B. Seim, MD, MBA

    Associate Professor
    The Ohio State University Wexner Medical Center
    Columbus, OH, United States

  • LM

    Lauren E. Miller, MD, MBA

    Assistant Professor of Otolaryngology - Head and Neck Surgery
    Ohio State University
    Columbus, OH, United States

  • Catherine T. Haring, MD

    Assistant Professor
    The James Cancer Hospital & Solove Research Institute
    Columbus, OH, United States

    • Senior Author(s)

  • Stephen Y. Kang, MD, FACS

    Professor
    The James Comprehensive Cancer Center
    Columbus, OH, United States

Disclosure(s):
Ryan T. Judd, MD: No relevant relationships to disclose.
Kyle K. VanKoevering, MD: No relevant relationships to disclose.
Matthew O. Old, MD: No relevant relationships to disclose.
Nolan B. Seim, MD, MBA: No relevant relationships to disclose.
Lauren E. Miller, MD, MBA: No relevant relationships to disclose.
Catherine T. Haring, MD: No relevant relationships to disclose.
Stephen Y. Kang, MD, FACS: No relevant relationships to disclose.


Introduction: There is ongoing debate regarding elective lateral neck dissection (END) during salvage total laryngectomy (TL) due to varied reported rates of occult nodal metastasis and postoperative complications. A recent meta-analysis found an occult nodal metastasis rate of 11%, but most studies included were small with varied survival outcomes, limiting generalized conclusions.

Methods: This was a retrospective review of all patients undergoing salvage TL for residual or recurrent local squamous cell carcinoma from 2009 to 2023 at a single comprehensive cancer center. Patients with clinico-radiologically positive nodal disease were excluded. Lateral END was undertaken at the surgeon’s discretion. Our primary and secondary outcomes were regional recurrence (RR) and rate of successful salvage treatment in patients with RR. Logistic and linear regressions were used for comparisons.

Results: There were 138 cN0 patients who underwent salvage TL (37% supraglottic and 42% glottic). 59 underwent END, and 79 underwent observation of the neck. Median follow-up was 17.9 months (IQR 7.7-38.1). The rate of occult nodal metastasis in END was 22.0% and was higher in supraglottic vs glottic tumors (33% vs 7%, p=0.024). In total, there were 21 RR with no difference based on tumor subsite (OR 1.21 [95% CI 0.43-3.4], p=0.712). There was no difference in RR between END and observation (8/59 vs 13/79, p=0.884). RR occurred significantly earlier in patients managed with observation of the neck (median 9.8 mos [IQR 4.5-15.2] vs 18.6 [8.3-28.9], p=0.044). There was a non-significant trend toward increased RR in patients with pathologic thyroid cartilage invasion (OR 2.87 [0.84-9.74], p=0.092). END patients with RR were more likely to undergo surgical salvage with subsequent long-term (>1 year) disease-free survival (OR 12 [1.01-141]. p=0.048).

Conclusions: In a large cohort of salvage TL, we found a relatively high rate of occult nodal metastasis, which was higher in supraglottic primaries. RR occurred earlier in the observation group and was less likely to be successfully salvaged.