Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer. This Task Force conducted a systematic search of the EMBASE, MEDLINE, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to the key questions. Evidence-based recommendations were then created on the basis of these articles. An external expert review and Delphi questionnaire were applied to reach consensus regarding the recommendations. The resulting guidelines focus on the surgical treatment of laryngeal cancer with the assumption that surgery is the selected treatment modality after a multidisciplinary discussion in any context. These guidelines do not, therefore, address non-surgical treatment such as radiation therapy or chemotherapy. The committee developed 62 evidence-based recommendations in 32 categories intended to assist clinicians during management of patients with laryngeal cancer and patients with laryngeal cancer, and counselors and health policy-makers.

/pdf/guidelines-for-the-surgical-management-of-laryngeal-cancer-2eiqbhg1r8.pdf

Guidelines for the Surgical Management of Laryngeal Cancer: Korean Society of Thyroid-Head and Neck Surgery

Salvage laryngectomy following organ-preservation therapy - An evidence-based review.

With the growing acceptance of nonsurgical therapies for laryngeal squamous cell carcinomas (LSCCs), it has become important to delineate surgical salvage strategies for disease recurrences. Total laryngectomy is often recommended, but appropriately selected laryngeal recurrences may be treated successfully with partial laryngeal surgery: laryngeal function can be preserved with oncological efficacy. The main available studies dealing with partial laryngeal surgery in recurrent carcinoma were critically reviewed. The most appealing feature of salvage transoral laser surgery (TLS) is the opportunity to make tumor-tailored excisions without any reconstructive limitations and retaining the option to switch to open partial laryngectomy. A recent detailed review of 11 series found a pooled local control rate of 57% after a first TLS procedure. Supracricoid laryngectomy (SCL) seems to achieve good local control rates in selected cases of recurrent supraglottic-glottic carcinoma: one review considering seven series calculated that 85% of the patients treated with salvage SCL after radiotherapy experienced no local recurrence; and total laryngectomy after failure of salvage SCL afforded an overall local control rate of 65%. Neck dissection is mandatory in all cases of local LSCC recurrence with evidence of neck metastases, and routine elective neck dissection is recommended for recurrent supraglottic and transglottic cancers.

Partial laryngeal surgery in recurrent carcinoma.

Salvage surgery for recurrence of laryngeal and hypopharyngeal squamous cell carcinoma: A retrospective study from 2005 to 2013.

Im Rahmen der Salvage Laryngektomie (SLE) bei Rezidivkarzinomen des Larynx und Hypopharynx wird haufig, wie bei der primaren Laryngektomie (LE), eine elektive
 beidseitige Neck dissection durchgefuhrt. Der therapeutische Nutzen muss angesichts des potentiell hoheren Morbiditatsrisikos nach definitiver
 Radiochemotherapie gegenuber den Risiken abgewogen werden. In einer retrospektiven Analyse wurden onkologische Parameter von Patienten erfasst, welche bei Rezidivkarzinomen des Larynx und Hypopharynx nach primarer
 Radiochemotherapie eine SLE mit beidseitiger Neck dissection erhielten. Zum Vergleich wurden Daten von Patienten mit primarer LE und beidseitiger Neck
 dissection bei Larynx- und Hypopharynxkarzinomen erfasst. 19 Patienten mit SLE und 83 Patienten mit LE wurden in die Analyse eingeschlossen. Bei der Mehrzahl der Patienten waren sowohl das initiale Tumorstadium als auch
 das Rezidiv-Tumorstadium vor SLE fortgeschritten. Vor SLE wiesen 5 % der Patienten (n = 1) klinisch metastasensuspekte Lymphknoten auf, vor LE 47 % (n = 39).
 Bei 17 % (n = 14) der Patienten mit LE wurden okkulte Lymphknotenmetastasen nachgewiesen, bei SLE lediglich bei 5 % der Patienten (n = 1). Insgesamt ergab sich
 ein pN+ -Stadium in 55 % (LE, n = 44) bzw. 10 % (SLE, n = 2) der Falle. Die Gesamtzahl der entfernten Lymphknoten bei LE war hoher als bei SLE (37,3 vs. 18,7, p
 Patienten, welche bei Rezidivkarzinomen des Larynx oder Hypopharynx nach primarer Bestrahlung eine SLE erhalten, weisen selten Lymphknotenmetastasen auf. Dennoch
 kommt es in Einzelfallen zu einer okkulten Metastasierung. Bei der Planung der letzten kurativen Therapieoption sollte dies in Betracht gezogen werden.

[The role of elective neck dissection during salvage laryngectomy - a retrospective analysis].

Among patients with head and neck squamous cell carcinoma with a negative neck who are initially treated with (chemo)radiotherapy, a number of cases will recur locally without obvious neck recurrence. There is little information available as to the most efficacious management of the neck in these cases. We have reviewed the literature to see what conclusions can be drawn from previous reports. We conducted a bibliography search on MEDLINE and EMBASE databases. Studies published in the English language and those on squamous cell carcinoma of the oral cavity, nasopharynx, oropharynx, larynx and hypopharynx were included. Data related to neck management were extracted from the articles. Twelve studies satisfied the inclusion criteria. Five studies reported only one treatment plan (either neck dissection or observation), while the others compared neck dissection to observation. The rate of occult metastases ranged from 3.4 to 12 %. The studies included a variable distribution of primary sites and stages of the recurrent primary tumors. The risk of occult neck node metastasis in a clinically rN0 patient correlated with tumor site and T stage. Observation of the neck can be suggested for patients with T1-2 glottic tumors, who recurred with less advanced tumors (rT1-2). For patients with more advanced laryngeal recurrences or recurrence at other high-risk sites, neck dissection could be considered for the rN0 patient, particularly if the neck was not included in the previous radiation fields.

Is elective neck dissection indicated during salvage surgery for head and neck squamous cell carcinoma

7. Weiss D, Koopmann M, Rudack C. Prevalence and impact on clinicopa-thological characteristics of human papillomavirus-16 DNA in cervicallymph node metastases of head and neck squamous cell carcinoma.Head Neck 2011;33:856–862.8. Armas GL, Su CY, Huang CC, Fang FM, Chen CM, Chien CY. Theimpact of virus in N3 node dissection for head and neck cancer. EurArch Otorhinolaryngol 2008;265:1379–1384.9. Barwad A, Sood S, Gupta N, Rajwanshi A, Panda N, Srinivasan R.Human papilloma virus associated head and neck cancer: a PCR basedstudy. Diagn Cytopathol 2011;Epub ahead of print.10. Hoffmann M, Gottschlich S, G€or €ogh T, et al. Human papillomaviruses inlymph node neck metastases of head and neck cancers. Acta Otolaryngol2005;125:415–421.11. Desai PC, Jaglal MV, Gopal P, et al. Human papillomavirus in metastaticsquamous carcinoma from unknown primaries in the head and neck: a ret-rospective 7 year study. Exp Mol Pathol 2009;87:94–98.12. Compton AM, Moore-Medlin T, Herman-Ferdinandez L, et al. Humanpapillomavirus in metastatic lymph nodes from unknown primary headand neck squamous cell carcinoma. Otolaryngol Head Neck Surg 2011;145:51–57.

Reply to the letter to the editor by Straetmans et al

Background. Metastatic involvement of the parotideal lymph nodes from cutaneous squamous cell carcinoma is rare in occurrence, but has a high prognostic value. The aim of the present study was to define a patient group with a high risk for development of regional metastasis and to determine the follow-up course and therapy of metastasis in these patients. Material and methods: Nineteen patients treated with malignancies of the parotid gland over a time period of four years were analyzed prospectively. Results. In 6 out of 19 patients the parotideal tumor proved to be a lymph node metastasis of previously treated poorly differentiated squamous cell carcinoma of the skin. The diameter of the primary tumor was at least 1.5 cm in 5 out of 6 cases. The time interval between detection of metastatic involvement of the parotid gland and diagnosis of a preexisting skin cancer was approximately 7 months. Metastastic infiltration of cervical lymph nodes could be shown in 4 patients. In one patient pulmonary metastases were detected. Conclusion. On the basis of data from the literature and the results presented here, patients who are at high risk for regional metastasis were defined. Clinical examination of the parotid gland and cervical lymph nodes should be performed frequently in these patients at least for 18 months after primary tumor diagnosis. Parotideal lymph node metastases of a squamous cell carcinoma of the head skin should have similar treatment to primary squamous cell carcinoma of the parotid gland provided that a curative option exists.

Parotideal lymph node metastasis in squamous cell carcinoma of the skin

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Is elective neck dissection indicated during salvage surgery for head and neck squamous cell carcinoma

Reply to the letter to the editor by Straetmans et al

Parotideal lymph node metastasis in squamous cell carcinoma of the skin