• Brandon L Prendes, Annick Aubin-Pouliot, Nitin Egbert, and William R Ryan.
• Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA bprendes@ohns.ucsf.edu.
• Otolaryngol Head Neck Surg. 2014 Sep 1; 151 (3): 462-7.

ObjectiveThis study aimed to assess the rate of occult metastases in patients with head and neck mucosal squamous cell carcinoma who have undergone therapeutic neck radiation, and then develop primary site recurrence, without clinical evidence of recurrent neck disease.Study DesignCase series with chart review.SettingTertiary care center.Subjects And MethodsHead and neck mucosal squamous cell carcinoma patients with N+ necks treated with primary radiation who developed primary site recurrence with radiologically resolved neck lymphadenopathy, treated with salvage primary-site surgery with or without elective cervical lymphadenectomy (ECL). Main outcome measures were rate of occult nodal metastases, complication rates, and disease-free survival.ResultsSixteen patients met inclusion criteria. Of 18 neck sides that underwent either ECL or observation for a mean follow-up of 26 months, 4 (22.2%) were found to have positive occult cervical metastases, all on the ipsilateral side of preradiation neck disease. Patients with advanced T-stage and/or free flap reconstruction were more likely to undergo cervical lymphadenectomy. Patients with persistent (as opposed to recurrent) primary site tumors had the highest rate of occult cervical metastases.ConclusionThe risk of occult nodal metastases of 22.2%, in this study, may be too high to justify routinely omitting elective cervical lymphadenectomy in this patient population. Lymphadenectomy should especially be considered in patients with persistent tumors, with advanced recurrent T-stage, and undergoing free flap reconstruction.© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

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