{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T01:05:35Z","timestamp":1773882335301,"version":"3.50.1"},"reference-count":30,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2022,3,5]],"date-time":"2022-03-05T00:00:00Z","timestamp":1646438400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The role of elective neck dissection during salvage surgery in patients with a clinically negative neck (cN0) is still discussed. The main objective of this work was to estimate the prevalence and predictive factors of occult neck nodes metastasis; we therefore aimed to evaluate the survival rate and the main oncologic outcomes of cN0 patients who underwent salvage total laryngectomy and elective bilateral neck dissection. In this retrospective observational study, we enrolled 80 cN0 patients affected by recurrent laryngeal cancer and who underwent salvage total laryngectomy and bilateral selective elective neck dissection. Several parameters were collected in order to find prognostic factors; finally, postoperative complications were reviewed and survival analysis was performed. Occult lymph node metastases were reported in 18 out of 80 patients (22.5%). Significant statistical correlation between lymphovascular invasion (p = 0.007), perineural invasion (p = 0.025) and occult nodal metastasis was found. Other variables (glottic subsite of recurrence, clinical T, pathological T, previous chemotherapy) were not significantly predictive of occult nodal metastasis. The 5-year OS, DSS, and RFS were 50.4%, 64.7%, and 63.4%, respectively. In conclusion, our single-institution data on a large cohort of patients, suggest performing routinely elective selective bilateral neck dissection during salvage total laryngectomy in cN0 patients due to the biological attitude of the tumor to spread to cervical nodes, considering an acceptable complications rate.<\/jats:p>","DOI":"10.3390\/jcm11051438","type":"journal-article","created":{"date-parts":[[2022,3,6]],"date-time":"2022-03-06T20:38:16Z","timestamp":1646599096000},"page":"1438","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Elective Neck Dissection during Salvage Total Laryngectomy: Personal Experience"],"prefix":"10.3390","volume":"11","author":[{"given":"Jacopo","family":"Galli","sequence":"first","affiliation":[{"name":"Unit of Otolaryngology\u2014Head and Neck Surgery, \u201cA. Gemelli\u201d Hospital Foundation IRCCS, 00168 Rome, Italy"},{"name":"Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Di Cintio","sequence":"additional","affiliation":[{"name":"Unit of Otolaryngology, \u201cNuovo Ospedale Degli Infermi\u201d, 13875 Ponderano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0104-1501","authenticated-orcid":false,"given":"Stefano","family":"Settimi","sequence":"additional","affiliation":[{"name":"Unit of Otolaryngology\u2014Head and Neck Surgery, \u201cA. Gemelli\u201d Hospital Foundation IRCCS, 00168 Rome, Italy"},{"name":"Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Salvati","sequence":"additional","affiliation":[{"name":"Airway Surgery Unit, Pediatric Surgery Department, \u201cBambino Ges\u00f9\u201d Children Hospital, 00165 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5878-7668","authenticated-orcid":false,"given":"Claudio","family":"Parrilla","sequence":"additional","affiliation":[{"name":"Unit of Otolaryngology\u2014Head and Neck Surgery, \u201cA. Gemelli\u201d Hospital Foundation IRCCS, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Almadori","sequence":"additional","affiliation":[{"name":"Unit of Otolaryngology\u2014Head and Neck Surgery, \u201cA. Gemelli\u201d Hospital Foundation IRCCS, 00168 Rome, Italy"},{"name":"Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gaetano","family":"Paludetti","sequence":"additional","affiliation":[{"name":"Unit of Otolaryngology\u2014Head and Neck Surgery, \u201cA. Gemelli\u201d Hospital Foundation IRCCS, 00168 Rome, Italy"},{"name":"Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1002\/lary.20675","article-title":"Management of the N0 neck in recurrent laryngeal squamous cell carcinoma","volume":"120","author":"Bohannon","year":"2010","journal-title":"Laryngoscope"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1017\/S0022215114000425","article-title":"Should elective neck dissection be routinely performed in patients undergoing salvage total laryngectomy?","volume":"128","author":"Pezier","year":"2014","journal-title":"J. Laryngol. Otol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1001\/jamaoto.2013.3995","article-title":"Elective Neck Dissection for N0 Neck During Salvage Total Laryngectomy","volume":"139","author":"Basheeth","year":"2013","journal-title":"JAMA Otolaryngol. Neck Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1111\/coa.12309","article-title":"Elective neck dissection during salvage total laryngectomy\u2014A beneficial prognostic effect in locally advanced recurrent tumours","volume":"40","author":"Hilly","year":"2015","journal-title":"Clin. Otolaryngol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1097\/00005537-199901000-00002","article-title":"Management of the N0 Neck During Salvage Laryngectomy","volume":"109","author":"Wax","year":"1999","journal-title":"Laryngoscope"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1016\/j.amjoto.2005.05.002","article-title":"Elective neck dissection during salvage laryngectomy","volume":"26","author":"Yao","year":"2005","journal-title":"Am. J. Otolaryngol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1002\/lary.24005","article-title":"Occult nodal disease in patients with failed laryngeal preservation undergoing surgical salvage","volume":"124","author":"Koss","year":"2014","journal-title":"Laryngoscope"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1007\/s00405-018-5257-0","article-title":"Elective neck treatment during salvage (pharyngo) laryngectomy","volume":"276","author":"Bernard","year":"2019","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1017\/S0022215114002709","article-title":"Is elective neck dissection necessary in cases of laryngeal recurrence after previous radiotherapy for early glottic cancer?","volume":"128","author":"Deganello","year":"2014","journal-title":"J. Laryngol. Otol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1055\/a-0619-5388","article-title":"Die Rolle der elektiven Neck dissection bei Salvage Laryngektomie\u2014Eine retrospektive Analyse","volume":"97","author":"Hussain","year":"2018","journal-title":"Laryngo-Rhino-Otologie"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1002\/hed.23145","article-title":"The role of elective neck dissection in patients undergoing salvage laryngectomy","volume":"35","author":"Amit","year":"2013","journal-title":"Head Neck"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1111\/coa.13266","article-title":"Surgical and pathological outcomes of elective neck dissection during salvage total laryngectomy","volume":"44","author":"Asimakopoulos","year":"2019","journal-title":"Clin. Otolaryngol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1177\/0194599815627811","article-title":"Occult Nodal Disease Prevalence and Distribution in Recurrent Laryngeal Cancer Requiring Salvage Laryngectomy","volume":"154","author":"Birkeland","year":"2016","journal-title":"Otolaryngol. Neck Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1016\/j.amjoto.2016.01.004","article-title":"Complications and oncologic outcomes following elective neck dissection with salvage laryngectomy for the N0 neck","volume":"37","author":"Freiser","year":"2016","journal-title":"Am. J. Otolaryngol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1002\/lary.20854","article-title":"Elective neck dissection during salvage surgery for locally recurrent head and neck squamous cell carcinoma after radiotherapy with elective nodal irradiation","volume":"120","author":"Dagan","year":"2010","journal-title":"Laryngoscope"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1097\/COC.0b013e3182568f9a","article-title":"Incidence of Subclinical Nodal Disease at the Time of Salvage Surgery for Locally Recurrent Head and Neck Cancer Initially Treated With Definitive Radiation Therapy","volume":"36","author":"Yirmibesoglu","year":"2013","journal-title":"Am. J. Clin. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1002\/hed.20837","article-title":"Supracricoid partial laryngectomy as salvage surgery for radiation therapy failure","volume":"30","author":"Deganello","year":"2008","journal-title":"Head Neck"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1002\/hed.20160","article-title":"Oncologic effectiveness of selective neck dissection in the N0 irradiated neck","volume":"27","author":"Solares","year":"2005","journal-title":"Head Neck"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1002\/lary.28323","article-title":"Elective neck dissection during salvage laryngectomy: A systematic review and meta-analysis","volume":"130","author":"Gross","year":"2020","journal-title":"Laryngoscope"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"4026","DOI":"10.1002\/hed.25907","article-title":"Elective neck dissection in patients with radio-recurrent and radio-residual squamous cell carcinoma of the larynx undergoing salvage total laryngectomy: Systematic review and meta-analysis","volume":"41","author":"Lin","year":"2019","journal-title":"Head Neck"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1001\/archotol.1994.01880310005001","article-title":"Use of Decision Analysis in Planning a Management Strategy for the Stage NO Neck","volume":"120","author":"Weiss","year":"1994","journal-title":"Arch. Otolaryngol.\u2014Head Neck Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1002\/hed.23337","article-title":"Pharyngocutaneous fistula after salvage laryngectomy: Impact of interval between radiotherapy and surgery, and performance of bilateral neck dissection","volume":"36","author":"Basheeth","year":"2014","journal-title":"Head Neck"},{"key":"ref_23","unstructured":"National Comprehensive Cancer Network (2021, December 26). NCCN Guidelines for Head and Neck Cancers (Ver 1.2022). Available online: https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/head-and-neck.pdf."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1001\/archotol.124.6.637","article-title":"Perineural Invasion in Squamous Cell Carcinoma of the Head and Neck","volume":"124","author":"Fagan","year":"1998","journal-title":"Arch. Otolaryngol. Neck Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.otohns.2008.10.019","article-title":"Perineural invasion of the major and minor nerves in laryngeal and hypopharyngeal cancer","volume":"140","author":"Cosgarea","year":"2009","journal-title":"Otolaryngol. Neck Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1288\/00005537-198610000-00015","article-title":"Prognostic implications of perineural spread in squamous carcinomas of the head and neck","volume":"96","author":"Soo","year":"1986","journal-title":"Laryngoscope"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2021","DOI":"10.1002\/hed.24860","article-title":"Prognostic indicators and survival in salvage surgery for laryngeal cancer","volume":"39","author":"Fletcher","year":"2017","journal-title":"Head Neck"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/S0196-0709(98)90100-4","article-title":"Prognostic significance of vascular and perineura invasion in cancer of the larynx","volume":"19","author":"Yilmaz","year":"1998","journal-title":"Am. J. Otolaryngol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1159\/000477127","article-title":"Epidemiology and Molecular Biology of Head and Neck Cancer","volume":"40","author":"Jou","year":"2017","journal-title":"Oncol. Res. Treat."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1016\/j.ijrobp.2018.12.009","article-title":"Perineural Invasion and Perineural Tumor Spread in Head and Neck Cancer","volume":"103","author":"Bakst","year":"2019","journal-title":"Int. J. Radiat. Oncol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/5\/1438\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:32:44Z","timestamp":1760135564000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/5\/1438"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,5]]},"references-count":30,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["jcm11051438"],"URL":"https:\/\/doi.org\/10.3390\/jcm11051438","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,5]]}}}