Nodal stage migration and occult metastases in salvage laryngo(pharyng)ectomy

Introduction: The role of elective neck dissection (END) in clinically node-negative patients undergoing primary or salvage total laryngectomy (STL) remains controversial. The aim of this study was to evaluate nodal stage migration and the rate of occult nodal metastases in patients undergoing primary versus salvage laryngo(pharyng)ectomy. Materials and Methods: In this retrospective single-center study, patients treated between 2010 and 2020 at a tertiary university hospital were included. All patients underwent preoperative ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET) as well as contrast-enhanced CT or MRI for staging. Clinical nodal status (cN) was compared with final pathological nodal classification (pN) to assess nodal stage migration and occult metastases (cN0 to pN+). Outcomes were analyzed descriptively and comparatively between primary and salvage surgery groups. Results: A total of 70 patients were included (32 primary surgery, 38 salvage surgery). Nodal upstaging occurred more frequently in the primary surgery group (38%) compared with the salvage group (18%). In the salvage cohort, 4 of 31 clinically node-negative patients (12.9%) were found to have occult nodal metastases. No nodal downstaging was observed in the salvage group. Conclusions: Nodal stage migration occurs in both primary and salvage laryngo(pharyng)ectomy. The observed rates of occult nodal disease, particularly in the salvage setting, support careful patient selection regarding END while balancing oncologic risk and procedure-related morbidity