A Risk‐Adapted Approach for Elective Neck Dissection in Salvage Total Laryngectomy: Revisiting the Role of Tumor Subsite and Occult Nodal Disease
Bibliographic record
Abstract
BACKGROUND: The role of elective neck dissection (END) during salvage total laryngectomy (STL) in clinically node-negative (cN0) patients remains controversial due to variable risks of occult nodal metastasis and surgical morbidity. METHODS: We conducted a multicenter retrospective study of 178 cN0 patients undergoing STL after radiotherapy (RT) or chemoradiotherapy (CRT). Rates of occult nodal disease, survival outcomes, and predictive factors were analyzed. RESULTS: Occult nodal metastases were found in 19.7% of cases, highest in hypopharyngeal (35.7%) and supraglottic (24.5%) tumors. Tumor subsite and lymphovascular invasion were independent predictors of nodal positivity, while prior chemotherapy reduced risk. Patients with occult nodal disease had significantly worse three-year overall and disease-specific survival. CONCLUSIONS: A risk-adapted approach to END in STL is recommended, particularly for supraglottic and hypopharyngeal tumors. Routine END may be unnecessary in low-risk subsites like glottic tumors. Prospective studies are needed to refine management strategies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".