ASO Author Reflections: Salvage Total Laryngectomy, the Last Resort for Patients with Residual, Recurrent or Second Prim
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Salvage Total Laryngectomy, the Last Resort for Patients with Residual, Recurrent or Second Primary Laryngeal and Hypopharyngeal Cancer in Times of Nonsurgical Organ Preserving Treatment Strategies Jens Debacker, MD1, Jeroen Meulemans, MD2,3 MD, MSc, PhD2,3
, Wouter Huvenne, MD, PhD1,4, and Vincent Vander Poorten,
Department of Head and Skin, Ghent University, Ghent, Belgium; 2Otorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Leuven, Belgium; 3Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium; 4Head and Neck Surgery, University Hospital Ghent, Ghent, Belgium
1
PAST
PRESENT
As a result of important landmark trials, the primary treatment for laryngeal and hypopharyngeal squamous cell carcinoma (SCC) shifted from surgery to nonsurgical organ-preserving strategies based on radiotherapy and chemotherapy.1,2 However, in 25–36% of patients undergoing these organ-preservation strategies, there is residual or recurrent cancer that requires salvage surgery.1,2 Consequently, salvage total laryngectomy (STL) proved a key element in increasing the patient’s survival when primary larynx-preserving strategies fail, with reported 5-year survival rates around 50%.3 Unfortunately, predicting which patients will do well after STL remains troublesome. Multiple prognosticators were found associated with a decreased survival, but these often resulted from small sample-size series, lacking a valid multivariable analysis of the data.
For our study, we collected the data of 405 patients who underwent STL for residual, recurrent, or second primary SCC of the larynx and hypopharynx after initial (chemo)radiation in four reference hospitals in Belgium.4 This represents, to the best of our knowledge, the largest uniform cohort of STL patients reported in the literature. The main goals were to report oncologic outcomes and identify negative prognostic factors influencing oncologic outcome. We observed a 5-year overall survival of 47.7% (95% confidence interval [CI] 42.0–53.2%) and a 5-year disease-specific survival of 68.7% (95% CI 63.7–73.7%). As a result of the considerable sample size, we were able to identify independent negative prognosticators in multivariable analysis: increasing clinical tumor stage of the residual/recurrent/second primary tumor; increasing number of metastatic cervical lymph nodes retrieved during therapeutic neck dissection; hypopharyngeal and supraglottic tumor location; positive section margin status and perineural invasion all proved robust independent negative prognostic variables. An interesting finding in patients with a preoperatively cN0 neck was the very low probability of occult lymph node metastases (3.18%) in the prophylactic lateral neck dissection specimens. Moreover, performing an elective lateral neck dissection in this cN0 group did not result in better oncologic outcomes in our multivariable analysis.
Jens Debacker and Jeroen Meulemans are to be considered shared first authors, as they contri
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