Need for Level V Neck Dissection in T3‐T4 Oral Squamous Cell Carcinoma

Abstract

Objectives: (1) Recognize the frequency of level V neck node involvement in T3-T4 oral squamous cell carcinoma. (2) Analyze the need of level V neck dissection with N0 - N1 neck in T3-T4 oral squamous cell carcinoma (SCC). Methods: Noninterventional, descriptive study from January 2011 to August 2012 at Dow University of Health Sciences & Civil Hospital Karachi, Pakistan, a tertiary care teaching hospital. Sampling was nonprobability and purposive. Histopathologically proven cases of squamous cell carcinoma of oral cavity with T3-T4 lesion and N0-N1 neck on basis of clinical examination and computed tomography scan findings were included in this study. All patients underwent modified radical neck dissection type-I along with excision of the primary growth. Results: Forty-nine patients fulfilling selection criteria were assessed on the basis of histopathological reports. At level I, metastatic lymph nodes were positive in 12 patients; 4 had positive nodes at level II and 2 each at level III and IV. However, none were positive at level V. Primary lesion was involving cheek in 40 and tongue in 9 cases. Histopathology revealed moderately differentiated SCC in 33 and well-differentiated SSC in 16 patients. Conclusions: Our study suggests that level V neck dissection is not needed in oral SCC with N0-N1 neck even in T3-T4 lesions. However, as the sample size is small, further study with a larger number of cases is required to establish future guidelines for the extent of neck node clearance in oral cancer.