When to address level I lymph nodes in neck dissections?
This article was presented at the Combined Otolaryngology Spring Meeting, Phoenix, AZ, May 30, 2009.
Received 21 August 2009; received in revised form 5 November 2009; accepted 24 November 2009.
Abstract
Objective
To investigate the involvement of level I neck lymph node groups in head and neck carcinoma and compare the effect of primary tumor sites, such as oral cavity (OC), oropharynx (OP), hypopharynx (HP), and larynx (Lx), on level I lymph node metastasis.
Study Design
Case series with chart review.
Setting
Comprehensive Cancer Center.
Subjects and Methods
A total of 243 patients with OC and laryngopharyngeal carcinoma who underwent neck dissections in the last three years were included in the study. The primary tumor site was OC, followed by OP, Lx, HP, and carcinoma of unknown primary (CUP).
Results
Level I was involved in 29 of 243 (11.9%) patients. The other levels were also positive in all but five (17.2%) level I–involved patients. The primary tumor site with level I lymph node metastasis was OC (19.1%), followed by CUP (11.1%), OP (9.8%), Lx (4.4%), and HP (0%). The Lx primary site involved level I only if there were multiple other adverse prognostic features, such as N3 neck, extracapsular spread, pathologic involvement of all resected lymph nodes, involvement of all levels I-V, and invasion of the submandibular gland.
Conclusion
Although the submandibular content is resected as part of radical and modified radical neck dissections, level I–sparing selective neck dissections could be a safe and effective surgical neck management strategy in appropriately selected patients with OP, Lx, and HP carcinoma.
aDepartment of Otolaryngology–Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Comprehensive Cancer Center, the Ohio State University, Columbus, OH
bDepartment of Otolaryngology–Head and Neck Surgery, Denizli Military Hospital, Denizli, Turkey
Corresponding author: Enver Ozer, MD, 456 W 10th Ave, suite 4A, Columbus, OH 43210
No sponsorships or competing interests have been disclosed for this article.
ABSTRACT