35 One disadvantage is that if patients require total laryngectomy with flap reconstruction in the future, obtaining suitable recipient vessels for anastomosis may be more problematic. Salvage Surgery Clinically evident nodal metastases at the time of recurrence require surgical extirpation simultaneous with laryngectomy. The treatment of cases with local recurrence of laryngeal Inhibitors,research,lifescience,medical cancer but without clinically evident
nodal metastases is more controversial. Traditionally, many authors have recommended elective dissection of the N0 neck, particularly with supraglottic cancers, in which case bilateral neck dissection was commonly required.76,77 However, the wider availability of better preoperative imaging has allowed other authors to challenge the need for elective neck dissection in the salvage setting, particularly Inhibitors,research,lifescience,medical among patients who were staged N0 before initial treatment.78,79 The reported incidence of positive nodes in patients undergoing elective neck dissection at the time of salvage laryngectomy ranges Inhibitors,research,lifescience,medical from 3% to
19%.45,76,77,79–82 Possible reasons for the wide range include differences in study inclusion criteria, and differences in preoperative imaging studies used to stage the neck at the time of recurrence. In our institution, we found an incidence of occult neck disease of 8% (5% of dissected heminecks) among patients with clinically rN0 necks which had been staged radiologically with preoperative CT scan.78 Bilateral neck dissection at the time of salvage laryngectomy has been reported to lead to a higher incidence of major complications including pharyngocutaneous fistula.45,78,80 Inhibitors,research,lifescience,medical Furthermore, elective neck
dissection in this group does not appear to confer any survival benefit.56,80,81 Therefore avoidance of neck dissection if feasible may be beneficial by reducing the morbidity and risk of complications of salvage laryngectomy. Outcomes of Treatment Five-year overall survival rates for patients with advanced Inhibitors,research,lifescience,medical larynx cancer range from 48% to 54%.32,43,44 For the most part, this does not appear to be affected by Histone demethylase choice of treatment, with the increased local recurrence rate seen in non-surgically treated patients offset by the ability of many of these patients to be LY317615 molecular weight salvaged by total laryngectomy at the time of recurrence. This would appear to lead to equal overall survival between surgically and non-surgically treated patients, but a higher rate of larynx preservation in the non-surgical group.14,43,44 However, with the increasing shift toward non-surgical treatment strategies, there are worrying recent reports regarding a decreased survival for larynx cancer.17 It has been suggested that this may be linked to less aggressive surgical treatment of the larynx and/or neck. Hoffman et al.