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The purpose of the research was to evaluate postoperative complications, functional outcome and survival after salvage laryngectomy. Second, to evaluate the management of the neck in combination with a laryngectomy in this group of patients. A retrospective analysis of all patients who underwent total laryngectomy for residual or recurrent squamous cell laryngeal carcinoma after (chemo)radiotherapy between November 1990 and June 2007 was performed. Of the 120 patients that were included, the complication rate was 56% (33% major and 23% minor). In univariate analyses, T-stage (p=0.05), bilateral neck dissection (p=0.09) and ASA score (p=0.08) showed a trend for postoperative major complications. Lymph node metastases were found in 26% of the neck dissection specimens, with a trend towards more regional disease at higher initial N-stage (p=0.06) and T-stage (p=0.08). Five-year disease specific survival was 58%. In univariate analyses pre-operative chemoradiation (vs. radiation) (p=0.0001), N3 neck (p=0.001) and positive surgical margins (p=0.02) were significant predictors for a worse disease specific survival, but only positive surgical margins (p<0.001) maintained significance in multivariate analysis. Eighty-seven percent of the patients were able to produce speech using a voice prosthesis, and 84% of the patients were able to have a 'normal' or 'soft' diet. There was an almost significant increase in mean body mass index (BMI) 6-12 months postoperative (p=0.057). Laryngectomy after radiotherapy offers good survival, with a substantial risk of complications and good functional outcome., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Different strategies are available for the management of patients with early (i.e. tumour stage one or two) oral or oropharyngeal carcinoma and a clinically negative neck., Material and Methods: In 2006, a questionnaire was sent to the eight head and neck cancer centres of the Dutch Head and Neck Oncology Cooperative Group. This questionnaire covered: the factors influencing the decision to perform an elective neck dissection; the neck staging procedure; and the types of neck dissection undertaken., Results: All eight questionnaires were returned completed. Respondents indicated that the site (n = 6), size (n = 7) and thickness (n = 6) of the primary tumour were important in decisions regarding elective neck dissection. Ultrasound-guided fine needle aspiration cytology was the most frequently used diagnostic technique (n = 7). Depending on the site and stage of the primary tumour presented, in the different cases 3-7 of the centres would perform an elective neck dissection. Selective neck dissections (i.e. levels I to III/IV) were more frequently performed than modified radical neck dissections., Conclusion: There was no uniformity regarding management of the clinically negative neck in patients with early stage oral and oropharyngeal carcinoma, within The Netherlands.

In cases of oral cavity cancer a reliable diagnostic technique is needed to detect occult regional lymph node metastases and to avoid futile elective neck dissections as well as undertreatment. The first studies revealed a sensitivity of 94%. However, the sentinel node procedure is not yet a routinely performed procedure in oral cancer.

Preserving the accessory nerve results in a better outcome of the shoulder function after neck dissection. However, little is known about the impact of preserving a cervical contribution to the accessory nerve. This study describes the shoulder function after different types of neck dissections, with the emphasis on the significance of the cervical contribution to the accessory nerve. Fifty-nine patients who underwent neck dissections of various types were included. Thirty-eight patients underwent unilateral radical or modified radical neck dissections, and 21 patients underwent bilateral neck dissections. All the patients were assessed subjectively and objectively, using a questionnaire and an inclinometer. Radical neck dissections inflicted significantly more morbidity than modified radical neck dissections. Preserving a cervical contribution to the accessory nerve did not decrease pain complaints or functional impairment. However, there might be some improvement in range of motion, especially exorotation and anteflexion. Preserving the accessory nerve has a positive influence on shoulder function and complaints. Preserving a cervical contribution does not decrease morbidity significantly.

The risk for post-operative exposure of the carotid artery due to skin flap necrosis after major head and neck surgery is increased after previous radiation and in severely malnourished patients. Eight patients are described who presented with an (imminent) carotid exposure one to eight weeks after surgery. Pectoralis major myofascial flap transfer with split thickness skin graft coverage was used for protection of the carotid artery. All cases were managed successfully and healed primarily in two to four weeks with acceptable cosmesis. We advocate immediate treatment in the event of an exposed carotid (or imminent exposure) by a pectoralis major myofascial flap with split-thickness skin grafting.

The status of the cervical lymph nodes is the single most important prognostic factor in head and neck cancer. Unfortunately, clinical assessment of the neck is not very accurate, although newer imaging techniques such as CT, MRI and ultrasound-guided fine needle aspiration cytology can be used to improve upon the results of clinical palpation alone. While diagnostic techniques remain less than 100% accurate, the risk of occult disease in the neck will remain. If this occurrence is judged to be greater than 15-20%, elective treatment to the neck may then be justified. When the neck is treated surgically, histological information can be gained which has both prognostic and therapeutic implications. Indications for the use of surgery and radiotherapy for the elective and therapeutic management of the neck and the results of such treatment are discussed.

We compared the results of transoral excision of the primary tumor with discontinuous neck dissection with the results of in-continuity dissection of primary tumor and neck nodes in anteriorly localized squamous cell carcinoma of the oral cavity. We analyzed 27 patients who underwent 28 discontinuous dissections and 34 patients who underwent 40 in-continuity dissections for T2 anterior tongue or floor-of-mouth carcinoma. The overall ipsilateral neck recurrence rate was 11%. The discontinuous dissection group did significantly worse than the in-continuity dissection group, with a neck recurrence rate of 19%. Consequently, the actuarial 5-year survival of patients who underwent a discontinuous dissection was substantially decreased (63%) compared with patients who were treated by an in-continuity dissection (80%). Discontinuous neck dissection, thus, is not to be recommended in oral cancer.

Neck recurrence-free curves corrected for local recurrence were compared for 494 patients who underwent 565 comprehensive neck dissections. In 42 dissections, no radicality could be obtained. Of the 523 histologically radical dissections, examination revealed tumor in 352 cases. Patients in whom three or more positive nodes or extranodal spread in one or more nodes were found received postoperative radiotherapy. In the histologically N0 group, the incidence of neck recurrence after 5 years was 3%; in the N+ group as a whole, it was 10%. Analysis of the influence of extranodal spread and the number of positive nodes showed that the group with one or two positive nodes without extranodal spread (that did not receive postoperative radiotherapy) did not statistically differ from the other groups. This suggests that the results of the group with one or two positive nodes without extranodal spread can be improved by postoperative radiotherapy.