Davies‐Husband CR, et al. - In the present study, the researchers sought to provide an revised, systematic and comprehensive summary of the literature on the management of the N0 neck in patients for whom primary irradiation for squamous cell carcinoma of the larynx was ineffective and salvage surgery recommended in the form of total laryngectomy (TL). Bibliographic databases MEDLINE, Cochrane, PubMed and Embase were searched from the beginning until April 2019, without any language restrictions. Impact of END on locoregional control, complication rate, disease specific and overall survival (DSS and OS) were identified as outcome measures. The primary search identified 19 eligible articles, consisting of 1,353 patients, (1,552 ENDs). Data reported that the overall risk of occult metastases was 14% (9% of ENDs). END may reduce the rate of regional recurrence during salvage TL but not at the cost of improving DSS or OS. Occult metastases rates, regional recurrence and “cure” by salvage neck dissection are not comparable. Significant bias in all the collated manuscripts would allow the reader to carefully interpret conclusions. Patients should be fully involved in the decision-making process, and their performance status and co-morbidities should be carefully taken into account when deciding to increase the extent of surgery, which the authors believe should remain limited to TL in the majority of cases.