Efficacy of routine bilateral neck dissection in the management of supraglottic cancer

OBJECTIVE: In a previous study, we reported that the contralateral undissected neck was the most common site of failure in patients treated for squamous cell carcinoma of the supraglottic larynx. Since then, we have altered our treatment of all patients with T2-T4 supraglottic cancer and selective T1 cases to include routine bilateral neck dissection. In the present study, we compare the long-term efficacy of routine bilateral neck dissections to historic controls in the treatment of patients with supraglottic cancer. STUDY DESIGN AND SETTING: A retrospective chart review on all patients undergoing primary surgery for supraglottic carcinoma between 1989 and 2000 was performed. All had undergone routine bilateral neck dissection. The most proximal area of recurrent disease was identified as the site of recurrence. Rates of recurrence, 2-year overall survival, and 2-year disease-specific survival were calculated. Results were compared to historical data using Fisher's exact test. RESULTS. Of 180 patients identified, 115 patients with minimum 2-year follow-up and meeting exclusion criteria were included in the analysis. Four patients (3.5%) experienced local recurrence, 9 patients (7.8%) had cervical recurrence, and 8 patients had distant spread (7.0%). Recurrence in the neck (7.8%) has been significantly reduced from the historical recurrence rate (20%) prior to instituting routine bilateral neck dissections (P = 0.009). The 2-year survival increased from 72% to 82.6% (P = 0.0408). CONCLUSION AND SIGNIFICANCE. Routine bilateral neck dissection decreases cervical recurrence and appears to improve survival in the management of supraglottic cancer.