management of cervical lymph nodes in patients with laryngeal carcinoma – patterns of failure

The purpose of our study was to show the patterns of regional failure when a neck dissection is chosen as part of a laryngeal cancer operation, focusing our interest on selective neck dissections. From January 1, 1987 through December 31, 1991, we performed 374 neck dissections on 207 previously untreated patients with laryngeal squamous cell carcinoma. Selective neck dissections represented the majority of all dissections performed (87%). The overall regional recurrence rate was 4.84% and the average duration of follow-up 58 months after operation. The regional in-field recurrence rate after selective neck dissections in postoperatively irradiated N2b and N1 cases was 12.5% and 8.3%, respectively. It seems that a more comprehensive neck dissection would not benefit these patients, because the majority of regional recurrences developed in the dissected field. Selective neck dissections with postoperative radiotherapy represent appropriate therapeutic and not only diagnostic procedures in the treatment of patients with laryngeal carcinoma, even in N2b cases.