Axillary metastases following total laryngectomy: an under-recognised pathway.

OBJECTIVES

Axillary lymph node metastases represent a rare and under-recognised pattern of disease progression in laryngeal squamous cell carcinoma, with limited data regarding their timing and clinical significance.

METHODS

We retrospectively reviewed all patients treated for advanced-stage laryngeal squamous cell carcinoma at two tertiary medical centres between 2017-2022, identifying cases that subsequently developed axillary lymph node metastases.

RESULTS

Five patients (3.6 per cent) developed axillary lymph node metastases, all following total laryngectomy, four after salvage surgery for recurrent disease. Mean interval from surgery to axillary lymph node metastases diagnosis was 9.9 ± 4.2 months. All tumours were moderately to poorly differentiated, and axillary involvement was frequently associated with mediastinal nodal disease. All patients received systemic therapy, including chemotherapy and/or immunotherapy, and three died of disease during follow-up.

CONCLUSION

Axillary lymph node metastases occurred within a relatively narrow time window after total laryngectomy, suggesting a non-random metastatic pattern. Awareness of this pathway is important for post-laryngectomy surveillance and interpretation of follow-up imaging.