A Retrospective Review of Dissection Type and Outcomes in Advanced Glottic Carcinoma

A Retrospective Review of Dissection Type and Outcomes in Advanced Glottic Carcinoma | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Retrospective Review of Dissection Type and Outcomes in Advanced Glottic Carcinoma Stephanie Soon, Ayaaz Habib, Winson Wong, Jemy Jose This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3969848/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Intro: Neck dissection is performed in the management of advanced laryngeal carcinoma due to the risk of metastases to cervical lymphatics. Current NCCN Guidelines and UK guidelines offer differing advice on glottic carcinoma, with NCCN recommending ipsilateral and/or bilateral dissection and UK recommending bilateral dissection. This paper aims to assess the outcomes of unilateral and bilateral neck dissection in surgically managed advanced glottic carcinoma. Method: Retrospective review of twenty-four patients with advanced glottic carcinoma (T3-4, N-N2b) from the years 2014-2020 who had as primary surgical treatment. Survival analysis, cox regression and fisher exact test were performed. Results: We found no statistically significant difference in 5-year overall survival and local recurrence between unilateral neck (ULN) dissection and bilateral neck dissection (BLN). Conclusion: While the data from this study shows no statistical significance between dissection type and survival, we suggest that ULN, based on published literature provides an equivalent survival outcome with a lower complication rate. Neck Dissection Advanced Glottic Carcinoma Head and Neck Cancer Overall Survival Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Key Points This study found there there is no statistically significant relationship between ULN, BLN and survival. This study found that there is no statistically significant relationship between ULN, BLN and local recurrence and/or distant metastases. This study also found that there is no statistically significant relationship between adjuvant therapy and local recurrence and/or distant metastases. While the data from this study shows no statistical significance between dissection type and survival, we suggest that ULN, based on published literature provides an equivalent survival outcome with a lower complication rate. Introduction Background/Rationale Laryngeal carcinoma is the 3rd most common head and neck cancer ( 1 ). A significant proportion of laryngeal carcinoma patients present with advanced staged cancer ( 2 ). Curative treatment options of advanced laryngeal carcinoma include surgery, (chemo)radiotherapy, or a combination of both. The proximity of the larynx to an extensive lymphatic network results in a high risk of metastases to cervical lymphatics ( 3 ). Despite modern radiological imaging, occult metastases are still found in 20–25% of T3-T4 laryngeal carcinomas [4–7]. Occult metastases have a significant effect on patient mortality with a single ipsilateral lymph node metastasis decreasing survival by about 50% ( 4 , 5 ). For this reason, neck dissection is often performed as part of surgical treatment. There is currently no clear consensus on the choice of ULN or BLN in elective management of N0 – N2b disease in advanced glottic carcinoma. This is reflected in differing guidelines - with NCCN guidelines suggesting the option of ULN or BLN( 6 , 7 ) and UK guidelines recommending BLN ( 8 ). However, BLN, as a more invasive surgery, carried an increased risk of complications such as wound infections, cranial nerve affection, bleeding, seroma, prolonged hospital stays, and reduced quality of life ( 9 , 10 ). Objectives This study aims to examine the survival and recurrence rates of bilateral and ipsilateral neck dissections in patients with advanced glottic carcinoma. Methods The STROBE reporting guidelines has been utilised in this study. Study Design and Data Source Patient information and demographic details were extracted retrospectively from the hospital database of a tertiary hospital. Participants and Setting Patient with newly diagnosed surgically treated glottic SCC of T3-4, N0-N2b disease between January 2014 – December 2020 were included. Variables Age, sex, stage and location of disease, treatment, survival time, recurrence, smoking and alcohol status, number of nodes positive for disease, extra capsular spread (ECS) or perineural invasion details were collected. Type of adjuvant treatment, if used, was also recorded. Patients were categorised into either ULN or BLN group. Bias A potential source of bias for this study is the small sample size. To address this potential source of bias, we examined published literature surrounding this topic and their outcomes. Study Size The inclusion criteria for this study was patients with advanced glottic carcinoma – staged T3-T4 between January 2014 – December 2020. All patients were treated at the same tertiary hospital. Quantitative Variables Survival analysis was conducted adjusting for the quantitative variables of age, stage of disease, adjuvant therapy and spread of cancer. Statistical Methods Fisher’s Exact test was used to compare recurrence in bilateral and unilateral dissection patients who received adjuvant therapy. Kaplan Meier Survival Analysis and Cox Regression were performed to compare the survival outcomes of bilateral versus unilateral dissection. The statistical software used was SPSS (Version 28.0.1) (IBM Corporation) and Microsoft Excel (Version 16.50). Statistical significance was set at p < 0.05. Ethical Considerations The study was granted an exemption on ethics approval by institution where the research took place as this is a retrospective review. The need for written informed consent was waived as the study is based on nonidentifiable data. Results Participants and Descriptive Data 46 patients with surgically treated laryngeal carcinoma staged T3-T4 were identified with 24 patients eligible for further analysis. There were 13 patients with N0, three with N1, seven with N2b and one with N2c nodal disease. Of these, 20 patients had ULN with 4 patients had BLN as part of a total laryngectomy. Age ranged from 51–82 years old (mean age 67) with 21 male and 3 female. 18 patients were current or previous smokers, with smoking information not available for the remaining patients. Outcome Data All BLN patients had T4 cancers. Of these, one had extracapsular spread (ECS) and three had no adverse features. ULN patients had cancers staged T3-T4. Of these 50% had no ECS, five had PNI, four had ECS and one had both ECS and PNI. Figure 1 shows Adjuvant Therapy in ULN vs. BLN Patients. Of patients who underwent ULN, 11 patients required adjuvant treatment. Of patients who underwent BLN, three had adjuvant therapy. Pathological assessment of neck dissection and subsequent adjuvant treatment is showed in Table 1. Nine patients were given adjuvant treatment based on adverse pathological features. Main Results Figure 2 compares N stage and local recurrence, measuring whether distant metastases of cancer occurred. A Fisher’s Exact test was performed to compare recurrence and/ or metastases rates with and without adjuvant therapy. Both ULN and BLN had no statistically significant Fisher’s Exact values (p > 0.05). No locoregional recurrence were identified in BLN group up to 6 years post treatment. Seven ULN patients had either local recurrence and/or distant metastases. Metastases and local recurrence occurred in one ULN patient. Distant metastases occurred in 25% (5/20) of ULN patients. Local recurrence occurred in 10% (2/20) of ULN patients. The most common area of metastasis was to the lungs – occurring in > 50% of patients with metastases. As seen in Fig. 2, 50% (12/24) of patients were N0 and had no local recurrence or metastases. Recurrence and/or metastases occurred in 25% of all patients. This was also the only patient with both local recurrence and metastases. All patients with disease recurrence and/or metastases had 0% 5-year overall survival (OS). Of patients without disease recurrence and/or metastases, 77.8% (14/18) had 5-year OS. The 5-year survival OS (overall survival) for ULN was 50% and 100% for BLN (as seen in Fig. 3). The 2-year OS for ULN is 70% and 100% for BLN. When the survival function was adjusted for the covariates of age, stage of disease, adjuvant therapy and spread of cancer, the 2-year OS for ULN was 65% and remained 100% for BLN. This is seen in Fig. 4, which shows the survival function for ULN vs. BLN considering the above listed covariates. However, there was no statistically significant difference in survival time (p = 0.086). Similarly, hazard ratio for the dissection types is not statistically significant (p > 0.05). This is shown in Fig. 5, which shows the hazard function of ULN vs. BLN, with the covariates listed above adjusted for. Table 1 Adjuvant Therapy vs Adverse Pathological Features Adverse Pathological Features Chemo(Radiotherapy) Radiotherapy No Adjuvant Therapy Total Extracapsular Spread 1 1 0 2 Perineural Invasion 0 0 4 4 Extracapsular Spread and Perineural Invasion 1 0 2 3 No Adverse Pathological Features 2 9 2 13 Discussion No international consensus exists for the surgical neck management of advanced glottic carcinomas. This can be reflected by the variation in different national guidelines. German guidelines recommend ULN for advanced glottic carcinoma, with BLN recommended in midline crossing tumours ( 1 ). NCCN guidelines recommend ULN for advanced glottic carcinoma ( 6 , 7 ). UK guidelines recommend ULN in node positive disease in T2B-T3 and BLN in node negative disease, and BLN in T4 carcinoma ( 1 , 8 ). Key Results The results of the study found that the 5-year overall survival for BLN patients was 100% and 50% for ULN patients survived. Of rates of local recurrence and/or distant metastases, BLN had a rate of 0% in our study. Local recurrence and/or distant metastases was most common in N2c patients (100% (1/1)). This was also the only patient in our study with both local recurrence and metastases. Of our patients with local recurrence and/or distant metastases, 0% had 5-year OS. Local recurrences rates with and without adjuvant therapy were not statistically significant. The reason for this was theorised by a study by Li et al. ( 11 ) that found a lower overall survival in patients who had chemotherapy, radiotherapy, and neck dissection. They theorised that this may be due to more advanced disease and a poorer prognosis in patients offered such therapy. In our study, four patients were treated with this trifecta. Three of these were staged T4N2b and one was staged T3N0. Of these, two died in one year and two survived. Of the two that died, both had PNI, and one had both ECS and PNI. Of the two that survived, one had ECS, and one had no adverse pathological features. This lack of statistically significant findings may be due to the small sample size of BLN patients in our study. Our study included a total sample size of 24 patients – of which 4 had BLN. The data was extracted from the database of patients with advanced (T3-4) glottic carcinoma over seven years at a tertiary hospital in the U.K. This resultant sample size can be attributed to the small group of patients having advanced glottic carcinoma in the general population. This can be seen in similar studies such as that of Tsushima et al( 12 ) that had a sample size of 21 glottic carcinoma patients and Deganello( 13 ) et al. that had a sample size of 19 patients with advanced glottic carcinoma. As such, the 2017 Korean Guidelines for the Surgical Management of Laryngeal Cancer by the Korean Society of Thyroid, Head and Neck Surgery notes the scarcity of literature on the use of BLN in glottic carcinoma ( 14 ). A 2013 study by Basheeth et al. ( 15 ) also found no statistically significant difference in survival whether BLN, ULN or no neck dissection was performed. Our study and that of Basheeth et al. ( 15 ) had a variance in recurrence rates with 25% in our study and 20–44% in theirs respectively. One reason for the variation could be the study population included. Basheeth et al.’s study comprised of patients with primary subsites of supraglottic, glottic, transglottic and subglottic carcinoma, whereas our study population consists of glottic and transglottic carcinoma patients. An increased risk of recurrence has been noted in patients with supraglottic cancer ( 16 ). A 2021 study of 445 patients by Cai et al. ( 17 ) found increased overall survival in patients with T3N0 glottic squamous cell carcinoma who had elective neck dissection. In this study, patients either had elective neck dissection or no neck dissection. A 2022 study by Anwar et al. ( 4 ) found an increased incidence of negative lymph nodes in primary glottic carcinoma, with lymph nodes negative in 39% of glottic carcinoma patients. ULN and BLN were not statistically significant for lymph node yield. A 2019 study by Tsushima et al. ( 12 ) of patients with T4 glottic carcinoma found the rates of occult neck metastases higher in the ipsilateral neck – occurring at rates of > 10% at ipsilateral levels IIA, III and VI. Conversely, no positive nodes were found at contralateral levels IIA and IIB. Bilateral neck dissection, as a more invasive surgery, carries an increased risk of complications such as haematoma, wound infection, and wound dehiscence ( 18 ). This can be seen in the studies by El-Hamshary et al. and Basheeth et al., which found significant associations between post operative complications and bilateral neck dissection ( 15 , 18 ). Tsushima et al. ( 12 ) recommend ULN of levels IIA, III and VI, with the omission of bilateral level IIB and IV to minimise post operative complications. Interpretation Based on our study findings we cannot say that statistically ULN provides better survival outcomes than BLN. However, we suggest that ULN provides an equivalent survival outcome in published literature with a lower rate of complications ( 15 , 18 ). Limitations This study has several limitations. As a retrospective study it is affected by selection bias. Furthermore, as this is reflective of clinical reality, there is a small sample size and unequal patient numbers in the two cohorts. This study is also affected by human factors such as the clinician’s arbitrary approach to neck dissection and adjuvant therapy. Despite these, we believe this study fills a gap in research and can provide valuable insight in informing patient and clinician decisions on treatment. Conclusion The findings of this study suggest that there is no statistically significant relationship between ULN, BLN and survival. This study also found that there is no statistically significant relationship between ULN, BLN and local recurrence and/or distant metastases. This study also found that there is no statistically significant relationship between adjuvant therapy and local recurrence and/or distant metastases. While the data from this study shows no statistical significance between dissection type and survival, we suggest that ULN, based on published literature provides an equivalent survival outcome with a lower complication rate. Declarations Ethical Approval: The study was granted an exemption on ethics approval by Hull University Teaching Hospitals Trust as this is a retrospective review. Consent to Publish: The need for written informed consent was waived as the study is based on nonidentifiable data. Funding: No funding was received to assist with the preparation of this manuscript. Data Availability: The data that supports the findings of this study are available from the corresponding author upon reasonable request. References Böttcher A, Betz CS, Bartels S, Schoennagel B, Münscher A, Bußmann L, et al. Rational surgical neck management in total laryngectomy for advanced stage laryngeal squamous cell carcinomas. J Cancer Res Clin Oncol [Internet]. 2021 Feb 1 [cited 2022 Aug 5];147(2):549–59. Available from: https://link.springer.com/article/10.1007/s00432-020-03352-1 Creaney G, McMahon AD, Ross AJ, Bhatti LA, Paterson C, Conway DI. Head and neck cancer in the UK: what was the stage before COVID-19? UK cancer registries analysis (2011-2018). Br Dent J [Internet]. 2022 Nov 11 [cited 2023 Aug 13];233(9):787. Available from: /pmc/articles/PMC9650177/ Didier D, Delphine G, Jean-Marie B, Mohammad S, Pascal P, Philippe L. Is Routine Bilateral Neck Dissection Absolutely Necessary in the Management of N0 CT Negative Neck in Patients with T4 Laryngeal Head and Neck Carcinoma? J Cancer Ther [Internet]. 2011 Aug 31 [cited 2022 Apr 30];2011(03):322–4. Available from: http://www.scirp.org/journal/PaperInformation.aspx?PaperID=6653 Anwar M, Dewidar H, Hareedy A, Gebril NE, Nassar A. Role of elective neck dissection with salvage laryngectomy. Egyptian Journal of Otolaryngology [Internet]. 2022 Dec 1 [cited 2022 Oct 4];38(1):1–6. Available from: https://ejo.springeropen.com/articles/10.1186/s43163-022-00249-3 Erdag TK, Guneri EA, Avincsal O, Sarioglu S, Ecevit MC, Guneri A, et al. Is elective neck dissection necessary for the surgical management of T2N0 glottic carcinoma? Auris Nasus Larynx [Internet]. 2013 Feb 1 [cited 2022 Oct 4];40(1):85–8. Available from: http://www.aurisnasuslarynx.com/article/S0385814611002483/fulltext National Comprehensive Cancer Network. Version 1.2020 [Internet]. 2020. Available from: https://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf. Accessed 10 Mar 2020. Pfister D, Spencer S, Adkins D, Birkeland A, Brizel D, Busse P. 2024 NCCN Head and Neck Cancer Guidelines. 2023 Oct. Jones TM, De M, Foran B, Harrington K, Mortimore S. Laryngeal cancer: United Kingdom National Multidisciplinary guidelines. J Laryngol Otol [Internet]. 2016;75–82. Available from: http://info. Rodrigo JP, Cabanillas R, Franco V, Suárez C. Efficacy of routine bilateral neck dissection in the management of the N0 neck in T1–T2 unilateral supraglottic cancer. Head Neck [Internet]. 2006 Jun 1 [cited 2022 Aug 5];28(6):534–9. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/hed.20359 Nibu KI, Ebihara Y, Ebihara M, Kawabata K, Onitsuka T, Fujii T, et al. Quality of life after neck dissection: a multicenter longitudinal study by the Japanese Clinical Study Group on Standardization of Treatment for Lymph Node Metastasis of Head and Neck Cancer. Int J Clin Oncol [Internet]. 2010 Feb [cited 2022 Apr 30];15(1):33–8. Available from: https://pubmed.ncbi.nlm.nih.gov/20101430/ Li P, Hu W, Zhu Y, Liu J. Treatment and predictive factors in patients with recurrent laryngeal carcinoma: A retrospective study. Oncol Lett [Internet]. 2015 Nov 1 [cited 2023 Aug 13];10(5):3145–52. Available from: /pmc/articles/PMC4665650/ Tsushima N, Hayashi R, Shinozaki T, Tomioka T, Okano W, Ikeda M. The role of elective neck dissection for cT4aN0 glottic squamous cell carcinoma. JJCO Japanese Journal of Clinical Oncology Japanese Journal of Clinical Oncology [Internet]. 2019 [cited 2022 Oct 4];49(6):525–8. Available from: https://academic.oup.com/jjco/article/49/6/525/5370160 Deganello A, Gitti G, Meccariello G, Parrinello G, Mannelli G, Gallo O. Effectiveness and pitfalls of elective neck dissection in N0 laryngeal cancer. Acta Otorhinolaryngologica Italica [Internet]. 2011 Aug [cited 2023 Aug 13];31(4):216. Available from: /pmc/articles/PMC3203726/ Ahn SH, Hong HJ, Kwon SY, Kwon KH, Roh JL, Ryu J, et al. Guidelines for the surgical management of laryngeal cancer: Korean society of Thyroid-head and neck Surgery. Clin Exp Otorhinolaryngol. 2017 Mar 1;10(1):1–43. Basheeth N, O’Leary G, Sheahan P. Elective Neck Dissection for N0 Neck During Salvage Total Laryngectomy: Findings, Complications, and Oncological Outcome. JAMA Otolaryngology–Head & Neck Surgery [Internet]. 2013 Aug 1 [cited 2022 Oct 4];139(8):790–6. Available from: https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/1729108 Brandstorp-Boesen J, Falk RS, Evensen JF, Boysen M, Brøndbo K. Risk of Recurrence in Laryngeal Cancer. PLoS One [Internet]. 2016 Oct 1 [cited 2023 Aug 13];11(10). Available from: /pmc/articles/PMC5055342/ Cai Z, Chen L, Zhang J, Wen Y, Lei W. Improving Survival of T3cN0M0 Glottic Squamous Cell Cancer With Elective Neck Dissection. Laryngoscope [Internet]. 2022 Sep 1 [cited 2023 Aug 13];132(9):1807–16. Available from: https://pubmed.ncbi.nlm.nih.gov/34873700/ Abdel Samea H, Elhamshary AA, Abdelaziz M, Abu Shady E, hassan mohamed. Elective neck dissection during surgery for advanced glottic carcinoma with a clinically negative neck: Analysis of lymph node yield and early post-surgical outcomes. Benha Medical Journal [Internet]. 2022 Mar 1 [cited 2022 Oct 4];39(1):262–78. Available from: https://www.researchgate.net/publication/359082871_Elective_Neck_Dissection_during_Surgery_for_Advanced_Glottic_ Carcinoma_with_a_Clinically_Negative_Neck_Analysis_of_Lymph_Node_Yield_and_Early_Post-Surgical_Outcomes Additional Declarations No competing interests reported. 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distant metastases.\u003c/li\u003e\n \u003cli\u003eWhile the data from this study shows no statistical significance between dissection type and survival, we suggest that ULN, based on published literature provides an equivalent survival outcome with a lower complication rate.\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Introduction","content":"\n\u003ch3\u003eBackground/Rationale\u003c/h3\u003e\n\u003cp\u003eLaryngeal carcinoma is the 3rd most common head and neck cancer (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). A significant proportion of laryngeal carcinoma patients present with advanced staged cancer (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Curative treatment options of advanced laryngeal carcinoma include surgery, (chemo)radiotherapy, or a combination of both. The proximity of the larynx to an extensive lymphatic network results in a high risk of metastases to cervical lymphatics (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Despite modern radiological imaging, occult metastases are still found in 20\u0026ndash;25% of T3-T4 laryngeal carcinomas [4\u0026ndash;7]. Occult metastases have a significant effect on patient mortality with a single ipsilateral lymph node metastasis decreasing survival by about 50% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). For this reason, neck dissection is often performed as part of surgical treatment.\u003c/p\u003e \u003cp\u003eThere is currently no clear consensus on the choice of ULN or BLN in elective management of N0 \u0026ndash; N2b disease in advanced glottic carcinoma. This is reflected in differing guidelines - with NCCN guidelines suggesting the option of ULN or BLN(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) and UK guidelines recommending BLN (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). However, BLN, as a more invasive surgery, carried an increased risk of complications such as wound infections, cranial nerve affection, bleeding, seroma, prolonged hospital stays, and reduced quality of life (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eObjectives\u003c/h3\u003e\n\u003cp\u003eThis study aims to examine the survival and recurrence rates of bilateral and ipsilateral neck dissections in patients with advanced glottic carcinoma.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e The STROBE reporting guidelines has been utilised in this study.\u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Data Source\u003c/h2\u003e \u003cp\u003ePatient information and demographic details were extracted retrospectively from the hospital database of a tertiary hospital.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eParticipants and Setting\u003c/h2\u003e \u003cp\u003ePatient with newly diagnosed surgically treated glottic SCC of T3-4, N0-N2b disease between January 2014 \u0026ndash; December 2020 were included.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eVariables\u003c/h2\u003e \u003cp\u003eAge, sex, stage and location of disease, treatment, survival time, recurrence, smoking and alcohol status, number of nodes positive for disease, extra capsular spread (ECS) or perineural invasion details were collected. Type of adjuvant treatment, if used, was also recorded. Patients were categorised into either ULN or BLN group.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eBias\u003c/h2\u003e \u003cp\u003eA potential source of bias for this study is the small sample size. To address this potential source of bias, we examined published literature surrounding this topic and their outcomes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStudy Size\u003c/h2\u003e \u003cp\u003eThe inclusion criteria for this study was patients with advanced glottic carcinoma \u0026ndash; staged T3-T4 between January 2014 \u0026ndash; December 2020. All patients were treated at the same tertiary hospital.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eQuantitative Variables\u003c/h2\u003e \u003cp\u003eSurvival analysis was conducted adjusting for the quantitative variables of age, stage of disease, adjuvant therapy and spread of cancer.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Methods\u003c/h2\u003e \u003cp\u003eFisher\u0026rsquo;s Exact test was used to compare recurrence in bilateral and unilateral dissection patients who received adjuvant therapy. Kaplan Meier Survival Analysis and Cox Regression were performed to compare the survival outcomes of bilateral versus unilateral dissection. The statistical software used was SPSS (Version 28.0.1) (IBM Corporation) and Microsoft Excel (Version 16.50). Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eEthical Considerations\u003c/h2\u003e \u003cp\u003e The study was granted an exemption on ethics approval by institution where the research took place as this is a retrospective review. The need for written informed consent was waived as the study is based on nonidentifiable data.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\"\u003e\n \u003ch2\u003eParticipants and Descriptive Data\u003c/h2\u003e\n \u003cp\u003e46 patients with surgically treated laryngeal carcinoma staged T3-T4 were identified with 24 patients eligible for further analysis. There were 13 patients with N0, three with N1, seven with N2b and one with N2c nodal disease. Of these, 20 patients had ULN with 4 patients had BLN as part of a total laryngectomy. Age ranged from 51\u0026ndash;82 years old (mean age 67) with 21 male and 3 female. 18 patients were current or previous smokers, with smoking information not available for the remaining patients.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\"\u003e\n \u003ch2\u003eOutcome Data\u003c/h2\u003e\n \u003cp\u003eAll BLN patients had T4 cancers. Of these, one had extracapsular spread (ECS) and three had no adverse features. ULN patients had cancers staged T3-T4. Of these 50% had no ECS, five had PNI, four had ECS and one had both ECS and PNI. Figure\u0026nbsp;1 shows Adjuvant Therapy in ULN vs. BLN Patients. Of patients who underwent ULN, 11 patients required adjuvant treatment. Of patients who underwent BLN, three had adjuvant therapy. Pathological assessment of neck dissection and subsequent adjuvant treatment is showed in Table\u0026nbsp;1. Nine patients were given adjuvant treatment based on adverse pathological features.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\"\u003e\n \u003ch2\u003eMain Results\u003c/h2\u003e\n \u003cp\u003eFigure 2 compares N stage and local recurrence, measuring whether distant metastases of cancer occurred. A Fisher\u0026rsquo;s Exact test was performed to compare recurrence and/ or metastases rates with and without adjuvant therapy. Both ULN and BLN had no statistically significant Fisher\u0026rsquo;s Exact values (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\n \u003cp\u003eNo locoregional recurrence were identified in BLN group up to 6 years post treatment. Seven ULN patients had either local recurrence and/or distant metastases. Metastases and local recurrence occurred in one ULN patient. Distant metastases occurred in 25% (5/20) of ULN patients. Local recurrence occurred in 10% (2/20) of ULN patients. The most common area of metastasis was to the lungs \u0026ndash; occurring in \u0026gt;\u0026thinsp;50% of patients with metastases. As seen in Fig.\u0026nbsp;2, 50% (12/24) of patients were N0 and had no local recurrence or metastases. Recurrence and/or metastases occurred in 25% of all patients. This was also the only patient with both local recurrence and metastases. All patients with disease recurrence and/or metastases had 0% 5-year overall survival (OS). Of patients without disease recurrence and/or metastases, 77.8% (14/18) had 5-year OS.\u003c/p\u003e\n \u003cp\u003eThe 5-year survival OS (overall survival) for ULN was 50% and 100% for BLN (as seen in Fig.\u0026nbsp;3). The 2-year OS for ULN is 70% and 100% for BLN. When the survival function was adjusted for the covariates of age, stage of disease, adjuvant therapy and spread of cancer, the 2-year OS for ULN was 65% and remained 100% for BLN. This is seen in Fig.\u0026nbsp;4, which shows the survival function for ULN vs. BLN considering the above listed covariates. However, there was no statistically significant difference in survival time (p\u0026thinsp;=\u0026thinsp;0.086). Similarly, hazard ratio for the dissection types is not statistically significant (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). This is shown in Fig.\u0026nbsp;5, which shows the hazard function of ULN vs. BLN, with the covariates listed above adjusted for.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e \u003cstrong\u003eAdjuvant Therapy vs Adverse Pathological Features\u003c/strong\u003e\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Taba\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAdverse Pathological Features\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eChemo(Radiotherapy)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRadiotherapy\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo Adjuvant Therapy\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eExtracapsular Spread\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerineural Invasion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eExtracapsular Spread and Perineural Invasion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo Adverse Pathological Features\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eNo international consensus exists for the surgical neck management of advanced glottic carcinomas. This can be reflected by the variation in different national guidelines. German guidelines recommend ULN for advanced glottic carcinoma, with BLN recommended in midline crossing tumours (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). NCCN guidelines recommend ULN for advanced glottic carcinoma (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). UK guidelines recommend ULN in node positive disease in T2B-T3 and BLN in node negative disease, and BLN in T4 carcinoma (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eKey Results\u003c/h2\u003e \u003cp\u003eThe results of the study found that the 5-year overall survival for BLN patients was 100% and 50% for ULN patients survived. Of rates of local recurrence and/or distant metastases, BLN had a rate of 0% in our study. Local recurrence and/or distant metastases was most common in N2c patients (100% (1/1)). This was also the only patient in our study with both local recurrence and metastases. Of our patients with local recurrence and/or distant metastases, 0% had 5-year OS. Local recurrences rates with and without adjuvant therapy were not statistically significant. The reason for this was theorised by a study by Li et al. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) that found a lower overall survival in patients who had chemotherapy, radiotherapy, and neck dissection. They theorised that this may be due to more advanced disease and a poorer prognosis in patients offered such therapy. In our study, four patients were treated with this trifecta. Three of these were staged T4N2b and one was staged T3N0. Of these, two died in one year and two survived. Of the two that died, both had PNI, and one had both ECS and PNI. Of the two that survived, one had ECS, and one had no adverse pathological features.\u003c/p\u003e \u003cp\u003eThis lack of statistically significant findings may be due to the small sample size of BLN patients in our study. Our study included a total sample size of 24 patients \u0026ndash; of which 4 had BLN. The data was extracted from the database of patients with advanced (T3-4) glottic carcinoma over seven years at a tertiary hospital in the U.K. This resultant sample size can be attributed to the small group of patients having advanced glottic carcinoma in the general population. This can be seen in similar studies such as that of Tsushima et al(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) that had a sample size of 21 glottic carcinoma patients and Deganello(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) et al. that had a sample size of 19 patients with advanced glottic carcinoma. As such, the 2017 Korean Guidelines for the Surgical Management of Laryngeal Cancer by the Korean Society of Thyroid, Head and Neck Surgery notes the scarcity of literature on the use of BLN in glottic carcinoma (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA 2013 study by Basheeth et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) also found no statistically significant difference in survival whether BLN, ULN or no neck dissection was performed. Our study and that of Basheeth et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) had a variance in recurrence rates with 25% in our study and 20\u0026ndash;44% in theirs respectively. One reason for the variation could be the study population included. Basheeth et al.\u0026rsquo;s study comprised of patients with primary subsites of supraglottic, glottic, transglottic and subglottic carcinoma, whereas our study population consists of glottic and transglottic carcinoma patients. An increased risk of recurrence has been noted in patients with supraglottic cancer (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA 2021 study of 445 patients by Cai et al. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) found increased overall survival in patients with T3N0 glottic squamous cell carcinoma who had elective neck dissection. In this study, patients either had elective neck dissection or no neck dissection.\u003c/p\u003e \u003cp\u003eA 2022 study by Anwar et al. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) found an increased incidence of negative lymph nodes in primary glottic carcinoma, with lymph nodes negative in 39% of glottic carcinoma patients. ULN and BLN were not statistically significant for lymph node yield.\u003c/p\u003e \u003cp\u003eA 2019 study by Tsushima et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) of patients with T4 glottic carcinoma found the rates of occult neck metastases higher in the ipsilateral neck \u0026ndash; occurring at rates of \u0026gt;\u0026thinsp;10% at ipsilateral levels IIA, III and VI. Conversely, no positive nodes were found at contralateral levels IIA and IIB.\u003c/p\u003e \u003cp\u003eBilateral neck dissection, as a more invasive surgery, carries an increased risk of complications such as haematoma, wound infection, and wound dehiscence (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). This can be seen in the studies by El-Hamshary et al. and Basheeth et al., which found significant associations between post operative complications and bilateral neck dissection (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Tsushima et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) recommend ULN of levels IIA, III and VI, with the omission of bilateral level IIB and IV to minimise post operative complications.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eInterpretation\u003c/h2\u003e \u003cp\u003eBased on our study findings we cannot say that statistically ULN provides better survival outcomes than BLN. However, we suggest that ULN provides an equivalent survival outcome in published literature with a lower rate of complications (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study has several limitations. As a retrospective study it is affected by selection bias. Furthermore, as this is reflective of clinical reality, there is a small sample size and unequal patient numbers in the two cohorts. This study is also affected by human factors such as the clinician\u0026rsquo;s arbitrary approach to neck dissection and adjuvant therapy. Despite these, we believe this study fills a gap in research and can provide valuable insight in informing patient and clinician decisions on treatment.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings of this study suggest that there is no statistically significant relationship between ULN, BLN and survival. This study also found that there is no statistically significant relationship between ULN, BLN and local recurrence and/or distant metastases. This study also found that there is no statistically significant relationship between adjuvant therapy and local recurrence and/or distant metastases.\u003c/p\u003e \u003cp\u003eWhile the data from this study shows no statistical significance between dissection type and survival, we suggest that ULN, based on published literature provides an equivalent survival outcome with a lower complication rate.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval:\u0026nbsp;\u003c/strong\u003eThe study was granted an exemption on ethics approval by Hull University Teaching Hospitals Trust as this is a retrospective review.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish:\u003c/strong\u003e The need for written informed consent was waived as the study is based on nonidentifiable data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e No funding was received to assist with the preparation of this manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability:\u0026nbsp;\u003c/strong\u003eThe data that supports the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eB\u0026ouml;ttcher A, Betz CS, Bartels S, Schoennagel B, M\u0026uuml;nscher A, Bu\u0026szlig;mann L, et al. Rational surgical neck management in total laryngectomy for advanced stage laryngeal squamous cell carcinomas. J Cancer Res Clin Oncol [Internet]. 2021 Feb 1 [cited 2022 Aug 5];147(2):549\u0026ndash;59. Available from: https://link.springer.com/article/10.1007/s00432-020-03352-1\u003c/li\u003e\n\u003cli\u003eCreaney G, McMahon AD, Ross AJ, Bhatti LA, Paterson C, Conway DI. Head and neck cancer in the UK: what was the stage before COVID-19? UK cancer registries analysis (2011-2018). Br Dent J [Internet]. 2022 Nov 11 [cited 2023 Aug 13];233(9):787. Available from: /pmc/articles/PMC9650177/\u003c/li\u003e\n\u003cli\u003eDidier D, Delphine G, Jean-Marie B, Mohammad S, Pascal P, Philippe L. Is Routine Bilateral Neck Dissection Absolutely Necessary in the Management of N0 CT Negative Neck in Patients with T4 Laryngeal Head and Neck Carcinoma? J Cancer Ther [Internet]. 2011 Aug 31 [cited 2022 Apr 30];2011(03):322\u0026ndash;4. Available from: http://www.scirp.org/journal/PaperInformation.aspx?PaperID=6653\u003c/li\u003e\n\u003cli\u003eAnwar M, Dewidar H, Hareedy A, Gebril NE, Nassar A. Role of elective neck dissection with salvage laryngectomy. Egyptian Journal of Otolaryngology [Internet]. 2022 Dec 1 [cited 2022 Oct 4];38(1):1\u0026ndash;6. Available from: https://ejo.springeropen.com/articles/10.1186/s43163-022-00249-3\u003c/li\u003e\n\u003cli\u003eErdag TK, Guneri EA, Avincsal O, Sarioglu S, Ecevit MC, Guneri A, et al. Is elective neck dissection necessary for the surgical management of T2N0 glottic carcinoma? Auris Nasus Larynx [Internet]. 2013 Feb 1 [cited 2022 Oct 4];40(1):85\u0026ndash;8. Available from: http://www.aurisnasuslarynx.com/article/S0385814611002483/fulltext\u003c/li\u003e\n\u003cli\u003eNational Comprehensive Cancer Network. Version 1.2020 [Internet]. 2020. Available from: https://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf. Accessed 10 Mar 2020.\u003c/li\u003e\n\u003cli\u003ePfister D, Spencer S, Adkins D, Birkeland A, Brizel D, Busse P. 2024 NCCN Head and Neck Cancer Guidelines. 2023 Oct. \u003c/li\u003e\n\u003cli\u003eJones TM, De M, Foran B, Harrington K, Mortimore S. Laryngeal cancer: United Kingdom National Multidisciplinary guidelines. J Laryngol Otol [Internet]. 2016;75\u0026ndash;82. Available from: http://info.\u003c/li\u003e\n\u003cli\u003eRodrigo JP, Cabanillas R, Franco V, Su\u0026aacute;rez C. Efficacy of routine bilateral neck dissection in the management of the N0 neck in T1\u0026ndash;T2 unilateral supraglottic cancer. Head Neck [Internet]. 2006 Jun 1 [cited 2022 Aug 5];28(6):534\u0026ndash;9. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/hed.20359\u003c/li\u003e\n\u003cli\u003eNibu KI, Ebihara Y, Ebihara M, Kawabata K, Onitsuka T, Fujii T, et al. Quality of life after neck dissection: a multicenter longitudinal study by the Japanese Clinical Study Group on Standardization of Treatment for Lymph Node Metastasis of Head and Neck Cancer. Int J Clin Oncol [Internet]. 2010 Feb [cited 2022 Apr 30];15(1):33\u0026ndash;8. Available from: https://pubmed.ncbi.nlm.nih.gov/20101430/\u003c/li\u003e\n\u003cli\u003eLi P, Hu W, Zhu Y, Liu J. Treatment and predictive factors in patients with recurrent laryngeal carcinoma: A retrospective study. Oncol Lett [Internet]. 2015 Nov 1 [cited 2023 Aug 13];10(5):3145\u0026ndash;52. Available from: /pmc/articles/PMC4665650/\u003c/li\u003e\n\u003cli\u003eTsushima N, Hayashi R, Shinozaki T, Tomioka T, Okano W, Ikeda M. The role of elective neck dissection for cT4aN0 glottic squamous cell carcinoma. JJCO Japanese Journal of Clinical Oncology Japanese Journal of Clinical Oncology [Internet]. 2019 [cited 2022 Oct 4];49(6):525\u0026ndash;8. 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Available from: https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/1729108\u003c/li\u003e\n\u003cli\u003eBrandstorp-Boesen J, Falk RS, Evensen JF, Boysen M, Br\u0026oslash;ndbo K. Risk of Recurrence in Laryngeal Cancer. PLoS One [Internet]. 2016 Oct 1 [cited 2023 Aug 13];11(10). Available from: /pmc/articles/PMC5055342/\u003c/li\u003e\n\u003cli\u003eCai Z, Chen L, Zhang J, Wen Y, Lei W. Improving Survival of T3cN0M0 Glottic Squamous Cell Cancer With Elective Neck Dissection. Laryngoscope [Internet]. 2022 Sep 1 [cited 2023 Aug 13];132(9):1807\u0026ndash;16. Available from: https://pubmed.ncbi.nlm.nih.gov/34873700/\u003c/li\u003e\n\u003cli\u003eAbdel Samea H, Elhamshary AA, Abdelaziz M, Abu Shady E, hassan mohamed. Elective neck dissection during surgery for advanced glottic carcinoma with a clinically negative neck: Analysis of lymph node yield and early post-surgical outcomes. Benha Medical Journal [Internet]. 2022 Mar 1 [cited 2022 Oct 4];39(1):262\u0026ndash;78. Available from: https://www.researchgate.net/publication/359082871_Elective_Neck_Dissection_during_Surgery_for_Advanced_Glottic_\u003cbr/\u003eCarcinoma_with_a_Clinically_Negative_Neck_Analysis_of_Lymph_Node_Yield_and_Early_Post-Surgical_Outcomes\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Neck Dissection, Advanced Glottic Carcinoma, Head and Neck Cancer, Overall Survival","lastPublishedDoi":"10.21203/rs.3.rs-3969848/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3969848/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntro:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNeck dissection is performed in the management of advanced laryngeal carcinoma due to the risk of metastases to cervical lymphatics. Current NCCN Guidelines and UK guidelines offer differing advice on glottic carcinoma, with NCCN recommending ipsilateral and/or bilateral dissection and UK recommending bilateral dissection. This paper aims to assess the outcomes of unilateral and bilateral neck dissection in surgically managed advanced glottic carcinoma.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRetrospective review of twenty-four patients with advanced glottic carcinoma (T3-4, N-N2b) from the years 2014-2020 who had as primary surgical treatment. Survival analysis, cox regression and fisher exact test were performed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe found no statistically significant difference in 5-year overall survival and local recurrence between unilateral neck (ULN) dissection and bilateral neck dissection (BLN).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhile the data from this study shows no statistical significance between dissection type and survival, we suggest that ULN, based on published literature provides an equivalent survival outcome with a lower complication rate.\u003c/p\u003e","manuscriptTitle":"A Retrospective Review of Dissection Type and Outcomes in Advanced Glottic Carcinoma","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-23 18:30:28","doi":"10.21203/rs.3.rs-3969848/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"414f9057-ac6f-4c2e-8269-a7280201c5e8","owner":[],"postedDate":"February 23rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-02-27T16:31:43+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-23 18:30:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3969848","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3969848","identity":"rs-3969848","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}