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Objectives: Elective neck dissection during salvage laryngectomy is controversial. The goal of our study was to evaluate the effect of elective neck dissection during salvage laryngectomy in patients with locally advanced disease at recurrence., Design: Multicentre, retrospective study., Settings: Two tertiary medical centres., Participants: Eighty-seven patients treated by salvage laryngectomy., Main Outcome Measures: Disease-Free and Overall Survival., Results: Fifty-seven patients underwent salvage total laryngectomy for locally advanced recurrent squamous cell carcinoma of the larynx, and 30 patients underwent salvage laryngectomy for limited recurrent disease. Elective lateral neck dissection was performed in 48 patients. The groups were similar in age, sex, initial TNM stage and pre-operative treatment. Survival analysis showed that both disease-free survival and overall survival were improved in patients with locally advanced disease who underwent elective neck dissection. This beneficial effect was not demonstrated in patients with limited disease at recurrence. Multivariate analysis showed that the extent of the recurrent disease as well as elective neck dissection was associated with improved disease-free survival and overall survival., Conclusions: Elective neck dissection during salvage total laryngectomy seems to improve survival in patients with advanced local disease at recurrence. The role of neck dissection in the treatment of smaller tumours awaits further studies., (© 2014 John Wiley & Sons Ltd.)

Objectives/hypothesis: Elective neck dissection for the clinically negative neck is often a matter of debate. A decision-analysis model that was published in 1994 established the widely accepted principle that neck dissection is warranted when the risk for occult metastases is higher than 20%. The aim of the present study was to build a specific and up-to-date decision-analysis model to determine the need for elective neck dissection during salvage laryngectomy after chemoradiation failure and to identify the variables that effect the decision., Study Design: Decision-analysis model., Methods: A decision-analysis model was performed to compare the outcome of patients after salvage total laryngectomy with and without an elective neck dissection. Probabilities and expected utilities were derived from available literature to construct the model. Monte Carlo simulation and sensitivity analysis were used to calculate our models' outcomes and to identify the variables that influence the model most, respectively., Results: When calculating our model results with published data, we found that elective neck dissection is not warranted during salvage total laryngectomy. Optimal decision was found to be sensitive by two variables: 1) the probability for cure with neck dissection, and 2) the probability for regional-only recurrence after salvage laryngectomy without neck dissection. In multiway sensitivity analysis, only when cure rate with neck dissection exceeded 82%, adding neck dissection was the preferred decision. In practice, cure rates for patients after salvage total laryngectomy are around 50% to 65%., Conclusions: Based on our decision-analysis model, we do not recommend routine elective neck dissection during salvage total laryngectomy after failure of chemoradiation., (Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives: To investigate the prognostic significance of positive margin and disease course in partial laryngectomy for advanced laryngeal carcinoma and radiation failure., Design: Retrospective case control study., Setting: A major tertiary referral centre., Participants: Patients who underwent partial laryngectomy for advanced laryngeal carcinoma or for radiation failure with at least 2 years of follow-up., Main Outcome Measures: Margin status versus primary treatment and salvage treatment versus disease-free survival and overall survival., Results: Twenty nine patients with sufficient follow-up data were found. Twelve patients had histological positive margin. Five of the 12 patients with a histological positive margin failed surgery as did four patients with clear margins. A positive margin had no effect on disease-free survival (P = 0.287) but was associated with poorer overall survival (P = 0.051). Of 11 patients treated primarily with surgery, recurrence was documented in one of eight with a positive margin and none of three with clear margins. Of 18 patients who underwent surgery secondary to radiation failure, recurrence was documented in all four with a positive margin and 4 of 14 with negative margins. Extended frontolateral resection, performed only in radiation failures, was associated with worse disease-free survival., Conclusions: Non-irradiated patients with involvement of a single margin after partial laryngectomy may be spared total laryngectomy if adjuvant radiation is administered. Patients who fail radiation should undergo radical partial laryngectomy, with conversion to total laryngectomy in those with a positive margin., (© 2010 Blackwell Publishing Ltd.)

Objectives: The management of advanced laryngeal cancer has evolved in the last century, from total laryngectomy to chemoradiation. The aim of this study was to examine our experience with supracricoid partial laryngectomy as a possible solution for patients with advanced laryngeal tumours, with a focus on the oncological safety of the procedure and the functionality of the preserved larynges., Study Design: We reviewed the medical records of patients with laryngeal cancer who had undergone primary or salvage supracricoid partial laryngectomy at our department between 1998 and 2004., Results: Twenty-three patients treated with supracricoid partial laryngectomy for endolaryngeal squamous cell carcinoma were identified. Median follow-up time was 35 months. Twelve patients had advanced laryngeal tumours. Eight patients were radiation failures. These factors were not associated with increased local recurrence or with decreased survival., Conclusion: Supracricoid partial laryngectomy appears to be a feasible option for the treatment of laryngeal tumours, even in the advanced stage or after failure of radiation therapy.

Speech rehabilitation after total laryngectomy has often been neglected, and traditional methods of esophageal voice production are frequently unsuccessful or disappointing. The development of the tracheoesophageal puncture (TEP) technique and the valved voice prosthesis by Singer and Blom in 1979 offered patients an alternative method for laryngeal speech rehabilitation. This technique is now used successfully in an increasing number of patients after total laryngectomy. We present our experience with TEP since 1988 in 8 men and 1 woman, aged 50-86 years, who had adequate follow-up. In 5, primary TEP was performed at the same time as the total laryngectomy; in 4, secondary puncture was performed 12-18 months after primary surgery. 1 had serious operative complications, 2 had minor complications, 1 had long-term problems which necessitated discontinuing use of the prosthesis, while 8 achieved satisfactory voice use and could communicate effectively. We hope that further experience with TEP in Israel will confirm its effectiveness for speech rehabilitation after total laryngectomy.