title: Elective lymphadenectomy during salvage for locally recurrent head and neck squamous cell carcinoma after radiation.
abstract: OBJECTIVE
  This study aimed to assess the rate of occult metastases in patients with head and neck mucosal squamous cell carcinoma who have undergone therapeutic neck radiation, and then develop primary site recurrence, without clinical evidence of recurrent neck disease.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  Head and neck mucosal squamous cell carcinoma patients with N+ necks treated with primary radiation who developed primary site recurrence with radiologically resolved neck lymphadenopathy, treated with salvage primary-site surgery with or without elective cervical lymphadenectomy (ECL). Main outcome measures were rate of occult nodal metastases, complication rates, and disease-free survival.
  
  
  RESULTS
  Sixteen patients met inclusion criteria. Of 18 neck sides that underwent either ECL or observation for a mean follow-up of 26 months, 4 (22.2%) were found to have positive occult cervical metastases, all on the ipsilateral side of preradiation neck disease. Patients with advanced T-stage and/or free flap reconstruction were more likely to undergo cervical lymphadenectomy. Patients with persistent (as opposed to recurrent) primary site tumors had the highest rate of occult cervical metastases.
  
  
  CONCLUSIONS
  The risk of occult nodal metastases of 22.2%, in this study, may be too high to justify routinely omitting elective cervical lymphadenectomy in this patient population. Lymphadenectomy should especially be considered in patients with persistent tumors, with advanced recurrent T-stage, and undergoing free flap reconstruction.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA bprendes@ohns.ucsf.edu.
authors.forename: Brandon L
authors.initials: BL
authors.lastname: Prendes
authors.affiliation: University of California-San Francisco, School of Medicine, San Francisco, California, USA.
authors.forename: Annick
authors.initials: A
authors.lastname: Aubin-Pouliot
authors.affiliation: The Ohio State University College of Medicine, Columbus, Ohio, USA.
authors.forename: Nitin
authors.initials: N
authors.lastname: Egbert
authors.affiliation: Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA.
authors.forename: William R
authors.initials: WR
authors.lastname: Ryan
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy* / Q000556:secondary; D015331:Cohort Studies; D018572:Disease-Free Survival; D017558:Elective Surgical Procedures / Q000379:methods* / Q000401:mortality; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D012189:Retrospective Studies; D018570:Risk Assessment; D016879:Salvage Therapy / Q000379:methods / Q000401:mortality*; D012737:Sex Factors; D016019:Survival Analysis
keywords: cervical lymphadenectomy; elective; head and neck cancer; neck dissection; recurrent; salvage surgery; squamous cell carcinoma