Critical Appraisal of Watchful Waiting Policy in the Management of NO Neck of Advanced Laryngeal Carcinoma

OBJECTIVE: To analyze the problem of nodal recurrence of N0 neck advanced laryngeal carcinoma. DESIGN: Retrospective analysis. SETTING: Hospital referral center. PATIENTS: One hundred thirty-three patients with cancer stages T3-T4, N0, M0 who had total laryngectomy between January 1981 and December 1990. MAIN OUTCOME MEASURE: Nodal recurrence. RESULTS: Of the 11 patients who had elective radical neck dissections, there was no nodal recurrence. Of the other 122 patients who had no elective neck dissection, 19 patients (16%) developed nodal recurrence and all nodal recurrence was at levels II, III, and IV. Twelve patients (63%) underwent salvage radical neck dissection for nodal recurrence and they had a 38% adjusted 5-year actuarial survival rate. Of these 122 patients who had no elective neck dissection for the N0 neck, 12 patients (10%) eventually died of nodal recurrence. CONCLUSIONS: The watchful waiting policy is a satisfactory management option of N0 neck of advanced laryngeal carcinoma.