Is neck dissection necessary for early-stage laryngeal squamous cell carcinoma of the epiglottis or not?

The objectives of surgery for early to moderately advanced supraglottic cancer are cure of the tumor with preservation of voice, deglutition, and an intact airway. Yoshida et al. [1] performed a submucosal resection of a supraglottic tumor (T1 squamous cell carcinoma of the epiglottis), which is a conservative operation that protects the functional structure of the larynx. Although this treatment option seems to control the primary supraglottic cancer, it solves only part of the problem. The remaining issue is the high incidence of regional lymph node metastasis associated with supraglottic cancer, which ranges from 25 % to 50 %. Clinically, 30 % – 50 % of metastases are palpable, and 20 % – 40 % of clinically negative necks (N0) have occult metastases [2] [3] [4]. In addition, lymph node metastasis is the most important prognostic factor in supraglottic cancer. Most authors agree that, because of the high probability of occult neck metastasis, selective neck dissection should be performed even in patients with stage 1 and 2 disease [5] [6]. For this reason, this type of surgery would seem to be an undertreatment, and undertreating such patients will decrease their chances of survival because the highest probability of survival is always obtained by control of the disease in the neck.

Competing interests: None

References

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