Clinical observation of local laryngeal squamous cell carcinoma at cN_0 stage

Objective: To discuss the style of neck dissection applied in the patients with advanced laryngeal carcinoma at cN_0 stage and how to reduce the recurrent rate of lymph nodes metastases.Methods:The clinical data from eighty-seven patients with T~_(3-4) advanced laryngeal carcinoma at cN_0 stage were analyzed retrospectively.There are two methods for neck dissection: improved neck dissection and selective neck dissection.The distribution and pathological characteristics of positive lymph nodes were analyzed in both groups and the effects of neck dissection on prognosis of patients were observed.Kaplan-Meier method was used to calculate the recurrence rate of carcinoma and the trend of survival.Results: The occult lymph node metastasis rate was 36.8% in the whole group,and 40.4% in patients with supraglottic laryngeal carcinoma,and 32.5% in patients with glottic laryngeal carcinoma.The distribution of lymph node metastasis was 89.5%(17/19) in patients with supraglottic laryngeal carcinoma and 92.3%(12/13) in patients with glottic laryngeal carcinoma.The metastatic lymph nodes were mainly located at lateral levels II-III.The five-year recurrence rate was 13.5% in patients with occult lymph node metastasis and 6.7% in patients without occult lymph node metastasis.The five-year survival rate was 53.8% in the patients with occult lymph node metastasis and 71.1% in the patients without occult lymph node metastasis.Conclusion:The patients with advanced laryngeal carcinoma has higher occult lymph node metastasis rate.After selective neck dissection the recurrence rate between patients with and without occult lymph node metastasis is not significantly different.Selective neck dissection is necessary,especially at bilateral levels of II and III.