Levels II and III neck dissection for larynx cancer with N0 neck

Carlos Takahiro Chone,Hugo Fontana Kohler,Rodrigo Magalhães,Marcos Navarro,Albina Altemani,Agricio Nubiato Crespo

doi:10.5935/1808-8694.20120009

Carlos Takahiro Chone, Hugo Fontana Kohler + Show 4 more

Open Access

https://doi.org/10.5935/1808-8694.20120009

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Abstract

The removal of level II, III, and IV metastases has gained importance in the treatment of squamous cell carcinomas (SCC) of the neck and larynx. This study assessed the possibility of removing level II and level III metastases only, given the low likelihood of occurrence of metastatic lymph nodes on level IV in SCCs of the larynx. ObjectiveThis study aimed to analyze the prevalence rates of metastatic lymph nodes on level IV in laryngeal SCC patients. MethodsThis prospective study enrolled consecutive patients with laryngeal SCC submitted to neck lymph node dissection. Neck levels were identified and marked for future histopathology testing. ResultsSix percent (3/54) of the necks had level IV metastatic lymph nodes. All cN0 necks (42) were free from level IV metastasis. Histopathology testing done in the cN (+) necks (12) revealed that 25% of the level IV specimens were positive for SCC. The difference between cN0 and cN (+) necks was statistically significant (p = 0.009). Level IV metastases never occurred in isolation, and were always associated with level II or level III involvement (p = 0.002). ConclusionThe prevalence rate for lymph node metastasis in cN0 necks was 0%. Level IV metastatic lymph nodes were correlated to cN (+) necks. Level IV metastasis was associated with the presence of metastatic lymph nodes in levels II or III.

Highlights

The proposal of radical neck dissection for treatment of patients with head and neck squamous cell carcinoma (HNSCC) began with Crile in 19061
Level IV metastatic lymph nodes were correlated to cN (+) necks
Level IV metastasis was associated with the presence of metastatic lymph nodes in levels II or III

Summary

Introduction

The proposal of radical neck dissection for treatment of patients with head and neck squamous cell carcinoma (HNSCC) began with Crile in 19061. Based in the predictable pattern of neck metastasis for HNSCC2,3, selective neck dissection was developed, with dissection of most affected levels of neck. If these nodes bear no metastatic disease, the incidence of metastases in other levels is low and its elective removal is of questionable value. A study of 262 radical neck dissections[2,3], observed that metastatic disease occurred at levels II to IV, with sporadic metastasis to level I or V. Based on this findings, they proposed as elective treatment for these patients the dissection of levels II to IV. Dissection of levels II to IV is considered the treatment of choice for N0 laryngeal neoplasms[6] because the low probability of metastases to level V ranging between 0% and 7% in glottic SCC and 5% to 9% for supraglottic SCC1-5,7-11

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Discussion

Conclusion