End results of a prospective trial on elective lateral neck dissection vs type III modified radical neck dissection in the management of supraglottic and transglottic carcinomas.
BACKGROUND
Either modified type III radical neck dissection (MRND) or lateral neck dissections (LNDs) are considered valid treatments for patients with laryngeal carcinoma with clinically negative neck findings (N0). The object of this prospective study was to compare complications, neck recurrences, and survival results of elective MRND and LND on the management of laryngeal cancer patients. Patients and Methods This prospective randomized study began in 1990, and patient accrual was closed on December 1993. A total of 132 patients was included in the trial. All patients had previously untreated T2-T4 N0 M0 supraglottic or transglottic squamous cell carcinoma. No significant imbalance was found between groups with respect to demographic, clinical, pathologic, and other therapeutic variables. Seventy-one patients were given MRNDs (13 bilateral) and 61 were given LNDs (18 bilateral).


RESULTS
The false-negative rate was 26%, and most positive nodes were sited at levels II and III. Complications and period of hospitalization were similar in both groups. There were 6 ipsilateral neck recurrences (4 in the MRND group, and 2 in the LND group). The 5-year actuarial survival calculated by Kaplan-Meier method was 72.3% in the MRND group and 62. 4% in the LND group (log-rank test p =.312).


CONCLUSIONS
The rate of false-negative nodes in supraglottic and transglottic carcinomas was 26%, and most positive nodes were at levels II and III. The rates of 5-year overall survival, neck recurrences, and complications were similar in both groups. These results confirm the efficacy of lateral neck dissection in the elective treatment of the neck in patients with supraglottic and transglottic carcinomas.
Head and Neck Surgery Department, Hospital A. C. Camargo, Rua Professor Antonio Prudente, 211, 01509-010 - São Paulo, Brazil.
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009333:Neck; D037981:Neck Dissection / Q000009:adverse effects; D009364:Neoplasm Recurrence, Local; D011446:Prospective Studies; D015996:Survival Rate