Selective neck dissection for cervical node negative supraglottic carcinoma.

Objective: To investigate the incidence, localization, correlation to primary tumour and therapeutic results in supraglottic carcinoma patients with occult metastatic neck nodes.

Methods: The study included patients with supraglottic laryngeal carcinoma treated in the period 1976-1993. They all had clinically negative findings in the neck (N0) and had undergone primary surgery with curative intent. Bilateral selective neck dissection at the level II-IV was performed in all patients.

Results: One hundred ninety-three patients were studied. Occult cervical node metastases were found in 18% (35/193) of them. The incidence of occult metastases in cases with epilaryngeal primary tumour was 19% (14/72), while it was 17% (21/121) in supraglottic carcinoma excluding epilarynx. Ipsilateral occult metastases were more common (27/35, 77%), but both bilateral and contralateral spread was also seen (5/35, 14% and 3/35, 9%, respectively). Postoperative radiotherapy was delivered to all patients with confirmed occult metastases. Only in 2 (1%) did metastases develop subsequently, indicating the effectiveness of the planned postoperative radiotherapy.

Conclusions: Considering the tendency of supraglottic carcinoma for frequent occult cervical metastases we believe that selective level II-IV cervical node dissection should be carried out, followed by locoregional radiotherapy in case of histologically confirmed nodal micrometastases.