Salvage Laryngectomy in Clinically N0 Patients: Is Elective Neck Dissection Indicated?

Objectives: This systematic review and meta-analysis investigated the role of elective neck dissection (END) in the salvage management of clinically N0 necks. Data Sources: PubMed/Medline, Google Scholar, and the Cochrane Library were systematically searched for relevant studies. Methods: Both electronic and manual search strategies were conducted within the abovementioned databases and included articles and reviews to find the relevant studies. Rates of occult nodal metastasis, survival outcomes, and postoperative complications were analyzed in N0 patients undergoing salvage laryngectomy with END. Fixed and random effects models were used to calculate pooled estimates of overall survival metastasis rates with 95% confidence intervals, and heterogeneity was assessed using tau2, I2, and Cochran's Q test. Statistical analyses were performed in R software with p < 0.05 as significant. Results: The included eight studies reported occult metastasis rates ranging from 4% to 10% in clinically N0 necks post-radiotherapy. Overall survival was approximately 52%, with mixed evidence on the survival advantage of END. Disease-free survival and recurrence-free survival rates ranged from 71.7% to 95.5% at 5 years. Complication rates associated with END were high, with up to 47.4% of patients experiencing postoperative morbidity. The metastasis rate was 10%-13% highlighting the ability of END to detect occult metastases. Conclusion: The survival benefits of END are not consistently supported by current evidence, while the significant morbidity associated with the procedure raises concerns about its routine use. A conservative approach may be more appropriate for clinically node-negative patients, particularly when weighed against the elevated risks of complications. END demonstrates moderate overall survival rates and an ability to detect occult metastases, but its role in improving long-term outcomes remains unclear. Larger prospective studies and randomized trials are needed to better define the indications and outcomes of END in the salvage management of clinically N0 necks.