Carcinoma of the larynx: selective approach to the management of cervical lymphatics.

Our experience with the surgical management of 472 patients with squamous cell carcinoma of the larynx suggests that more aggressive management of the N0 neck is effective in managing patients with laryngeal carcinoma. Only 3% of patients developed recurrence at the primary site. Patients with T3 and T4 carcinoma of the glottic larynx and all patients treated surgically for carcinoma of the supraglottic larynx should undergo routine elective neck dissection of the N0 neck. This is undertaken on the ipsilateral side for T3 and T4 glottic lesions. Selective neck dissection is undertaken bilaterally for patients with carcinoma of the supraglottic larynx irrespective of the side of the primary tumor. Distant metastasis develops as a sole site of recurrent disease in 9% of patients overall. Additionally, 14% of patients developed a second primary carcinoma sometime during the postoperative period. Strategies to prevent and manage these problems are the challenge for the future.