Belayat H. Siddiquee
Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh
Title: Role of Bilateral Selective Neck Dissection in surgical Management of Advance Laryngeal Carcinoma with No Neck
Biography
Biography: Belayat H. Siddiquee
Abstract
Advance laryngeal carcinoma with N0 neck is a condition where controversies about surgical management are still present. Clearance of the echelon groups of cervical lymph nodes in clinically and radiologically negative neck during surgery for laryngeal primary has got a positive impact on prognosis. We have treated 114 such cases over thirteen years (2001-2013). Fifty five (55) were glottic and 59 supraglottic carcinoma. Surgery was done both in primary and irradiated cases: Primary modality in 53 cases (Glottic-23 and Supraglottic-30) and 61 irradiated cases (Glottic-32 and Supraglottic-29). Two types of surgery offered were (1) Total Laryngectomy, (2) Total Laryngectomy+Bilateral Selective Neck Dissection of Level-II, III, IV lymph nodes (Bil.SND). Total laryngectomy was done in 41 cases (Glottic-20 and Supraglottic-21), Total Laryngectomy+Bil.SND in 73 cases (Glottic-35 and Supraglottic-38). Postoperative adjuvant radiotherapy was given according to demand of the postoperative histopathology. 97.37% (111 patients) were followed up for >2 years, 74.35% (85 cases) >3 years and 45.61% (52 cases) for >5 years. Recurrence detected in 15 cases of Glottic carcinoma, Laryngectomy group-11 (55%) and Laryngectomy+Bil.SND-04 cases (11.43%; p=0.001). In supraglottic carcinoma recurrence found in 20 cases, Laryngectomy group-11 (52.38%) and Laryngectomy+Bil.SND-09 cases (23, 68%; p=0.026). Most of the recurrence (68.18%) occurs in the neck if not addressed properly during surgery. Prophylactic Bilateral SND in advance carcinoma of the larynx with N0 neck has significant influence in reducing recurrence.