Prospective case-control study of efficacy of bilateral selective neck dissection in primary surgical treatment of supraglottic laryngeal cancers with clinically negative cervical findings (N0).
OBJECTIVE
To evaluate the efficacy of bilateral selective neck dissection of levels II-IV in elective and therapeutic management of the neck as a part of primary surgical treatment of patients with supraglottic laryngeal cancer and clinically negative cervical findings (N0).


METHODS
Institutional, observational, case-control study with historic control of patients who underwent primary supraglottic tumour surgery, and a prospective cohort of patient, who underwent, besides the operation of primary tumour, bilateral selective neck dissection (level II-IV).


METHODS
University, tertiary level hospital, national referral centre.


METHODS
The study included 193 patients with supraglottic cancer and without palpable or ultrasound positive cervical findings who were surgically treated from 1988 to 2005. Besides the operation of primary tumour, all patients in the study group underwent bilateral selective neck dissection (level II-IV). Patients in the control group (N = 51) underwent primary tumour operation only and were followed up regularly. In cases with postoperative regional recurrences, the radical neck dissection was performed. All patients with histopathological confirmation of occult metastases were administered radiotherapy treatment (60 Gy) in the postoperative period.


METHODS
Five-year overall survival rate.


RESULTS
Occult cervical metastases were found in 18% of patients. They were present in level II in 77.5%, in level III in 20% of cases and in one patient in level IV (2.5%); the extracapsular spread was observed in 20% of cases. Postoperative regional metastases were found in 4.15% of cases in the study group, and in 11.8% in the control group, which proved to be significantly higher. The five-year overall survival rate showed no significant difference between the study group and the control group.


CONCLUSIONS
The incidence of postoperative regional recurrences could be reduced by performing bilateral selective neck dissection simultaneously with primary tumour operation, but with no influence on the survival rate.
Faculty of Medicine, University of Belgrade, Belgrade, Serbia.|Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, Belgrade, Serbia.
V
V
Djordjevic
Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, Belgrade, Serbia.
B
B
Bukurov
Faculty of Medicine, University of Belgrade, Belgrade, Serbia.|Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, Belgrade, Serbia.
N
N
Arsovic
Faculty of Medicine, University of Belgrade, Belgrade, Serbia.|Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, Belgrade, Serbia.
M
M
Dimitrijevic
Faculty of Medicine, University of Belgrade, Belgrade, Serbia.|Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, Belgrade, Serbia.
S
S
Jesic
Faculty of Medicine, University of Belgrade, Belgrade, Serbia.|Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, Belgrade, Serbia.
V
V
Nesic
Faculty of Medicine, University of Belgrade, Belgrade, Serbia.|Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, Belgrade, Serbia.
Z
Z
Petrovic
D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome