Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-26T13:01:55.989Z Has data issue: false hasContentIssue false
  • English
  • Français

Relevance of level I and IIB neck dissection in laryngeal cancer

Published online by Cambridge University Press:  15 June 2012

S Wiegand ,
J Esters ,
H-H Müller ,
T Jäcker ,
M Roessler ,
J A Fasunla ,
J A Werner  and
A M Sesterhenn
S Wiegand
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Marburg, Germany
J Esters
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Marburg, Germany
H-H Müller
Affiliation:
Institute of Medical Biometry and Epidemiology, Marburg, Germany
T Jäcker
Affiliation:
Department of Anaesthesia and Critical Care, Marburg, Germany
M Roessler
Affiliation:
Institute of Pathology, Giessen and Marburg University Hospital, Marburg, Germany
J A Fasunla
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Marburg, Germany
J A Werner
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Marburg, Germany
A M Sesterhenn*
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Marburg, Germany
*
Address for correspondence: Prof Dr Andreas M Sesterhenn, Department of Otolaryngology, Head and Neck Surgery, UKGM, Marburg Campus, Baldingerstrasse, 35033 Marburg, Germany Fax: +49 6421 5866367 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

Dissection of neck levels I and IIB is time-consuming and can cause comorbidity. This study aimed to determine whether level I and IIB neck dissection was necessary in patients with laryngeal cancer and clinically detectable or nondetectable neck nodes.

Patients and methods:

This was a retrospective review of 73 patients with laryngeal cancer. Essential clinical data were obtained and analysed to determine the incidence of neck node metastasis in levels I and IIB.

Results:

Of the 48 patients with no clinically apparent neck nodes, none had level I metastases and only one had level IIB metastases. Of the patients with clinically detectable neck nodes, three of 21 patients had level I metastases and three of 25 patients had level IIB metastases; these six patients also had additional metastases in level IIA.

Conclusion:

Dissection of neck levels I and IIB is justifiable in laryngeal cancer patients with clinically detectable neck nodes and suspicious lymph nodes in the respective level or level IIA. However, in patients without clinically detectable neck nodes, preservation of levels I and IIB is oncologically safe, economical and reduces the risk of comorbidity.

Keywords

LarynxCarcinomaSquamous CellNeck Dissection
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 126 , Issue 8 , August 2012 , pp. 795 - 799
Copyright
Copyright © JLO (1984) Limited 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 Kramer, S, Marcial, VA, Pajak, TF, MacLean, CJ, Davis, LW. Prognostic factors for loco/regional control and metastasis and the impact on survival. Int J Radiat Oncol Biol Phys 1986;12:573–8CrossRefGoogle ScholarPubMed
2 Ferlito, A, Rinaldo, A, Silver, CE, Robbins, KT, Medina, JE, Rodrigo, JP et al. Neck dissection for laryngeal cancer. J Am Coll Surg 2008;207:587–93CrossRefGoogle ScholarPubMed
3 Clayman, GL, Frank, DK. Selective neck dissection of anatomically appropriate levels is as efficacious as modified radical neck dissection for elective treatment of the clinically negative neck in patients with squamous cell carcinoma of the upper respiratory and digestive tracts. Arch Otolaryngol Head Neck Surg 1998;124:348–52CrossRefGoogle Scholar
4 Ferlito, A, Rinaldo, A, Devaney, KO, Nakashiro, K, Hamakawa, H. Detection of lymph node micrometastases in patients with squamous cell carcinomas of the head and neck. Eur Arch Otorhinolaryngol 2008;265:1147–53CrossRefGoogle Scholar
5 Waldfahrer, F, Hauptmann, B, Iro, H. Lymph node metastasis of glottic laryngeal carcinoma [in German]. Laryngorhinootologie 2005;84:96–100 CrossRefGoogle ScholarPubMed
6 Ferlito, A, Silver, CE, Suarez, C, Rinaldo, A. Preliminary multi-institutional prospective pathologic and molecular studies support preservation of sublevel IIB and level IV for laryngeal squamous cell carcinoma with clinically negative neck. Eur Arch Otorhinolaryngol 2007;264:111–14Google Scholar
7 Wittekind, C, Meyer, H-J, Bootz, F, eds. International Union Against Cancer. TNM Classification of Malignant Tumours [in German], 6th edn. Berlin: Springer, 2002 Google Scholar
8 Clopper, C, Pearson, S. The use of confidence or fiducial limits illustrated in the case of the binomial. Biometrika 1934;26:404–13CrossRefGoogle Scholar
9 Wenig, BL, Applebaum, EL. The submandibular triangle in squamous cell carcinoma of the larynx and hypopharynx. Laryngoscope 1991;101:516–18Google Scholar
10 Cheng, PT, Hao, SP, Lin, YH, Yeh, AR. Objective comparison of shoulder dysfunction after three neck dissection techniques. Ann Otol Rhinol Laryngol 2000;109:761–6CrossRefGoogle ScholarPubMed
11 Leipzig, B, Suen, JY, English, JL, Barnes, J, Hooper, M. Functional evaluation of the spinal accessory nerve after neck dissection. Am J Surg 1983;146:526–30CrossRefGoogle ScholarPubMed
12 Candela, FC, Shah, J, Jaques, DP, Shah, JP. Patterns of cervical node metastases from squamous carcinoma of the larynx. Arch Otolaryngol Head Neck Surg 1990;116:432–5Google Scholar
13 Li, XM, Wei, WI, Guo, XF, Yuen, PW, Lam, LK. Cervical lymph node metastatic patterns of squamous carcinomas in the upper aerodigestive tract. J Laryngol Otol 1996;110:937–41CrossRefGoogle ScholarPubMed
14 Buckley, JG, MacLennan, K. Cervical node metastases in laryngeal and hypopharyngeal cancer: a prospective analysis of prevalence and distribution. Head Neck 2000;22:380–53.0.CO;2-E>CrossRefGoogle Scholar
15 dos Santos, CR, Goncalves, Filho J, Magrin, J, Johnson, LF, Ferlito, A, Kowalski, L. Involvement of level I neck lymph nodes in advanced squamous carcinoma of the larynx. Ann Otol Rhinol Laryngol 2001;110:982–4CrossRefGoogle Scholar
16 Byers, RM, Wolf, PF, Ballantyne, AJ. Rationale for elective modified neck dissection. Head Neck Surg 1998;10:160–7CrossRefGoogle Scholar
17 Mercante, G, Bacciu, A, Oretti, G, Ferri, T. Involvement of level I neck lymph nodes and submandibular gland in laryngeal and/or hypopharyngeal squamous cell carcinoma. J Otolaryngol 2006;35:108–11Google Scholar
18 Ferlito, A, Rinaldo, A. Level I dissection for laryngeal and hypopharyngeal cancer: is it indicated? J Laryngol Otol 1998;112:438–40Google Scholar
19 Werner, JA, Dünne, AA, Myers, JN. Functional anatomy of the lymphatic drainage system of the upper aerodigestive tract and its role in metastasis of squamous cell carcinoma. Head Neck 2003;25:322–32Google Scholar
20 Chone, CT, Crespo, AN, Rezende, AS, Carvalho, DS, Altemani, A. Neck lymph node metastases to the posterior triangle apex: evaluation of clinical and histopathological risk factors. Head Neck 2000;22:564–71Google Scholar
21 Koybasioglu, A, Uslu, S, Yilmaz, M, Inal, E, Ileri, F, Asal, K. Lymphatic metastasis to the supraretrospinal recess in laryngeal squamous cell carcinoma. Ann Otol Rhinol Laryngol 2002;111:96–9Google Scholar
22 Coskun, HH, Erisen, L, Basut, O. Selective neck dissection for clinically N0 neck in laryngeal cancer: is dissection of level IIb necessary? Otolaryngol Head Neck Surg 2004;131:655–9CrossRefGoogle ScholarPubMed
23 Corlette, TH, Cole, IE, Albsoul, N, Ayyash, M. Neck dissection of level IIb: is it really necessary? Laryngoscope 2005;115:1624–6CrossRefGoogle ScholarPubMed
24 Silverman, DA, El-Hajj, M, Strome, S, Esclamado, RM. Prevalence of nodal metastases in the submuscular recess (level IIb) during selective neck dissection. Arch Otolaryngol Head Neck Surg 2003;129:724–8Google Scholar
25 Elsheikh, MN, Mahfouz, ME, Salim, EI, Elsheikh, EA. Molecular assessment of neck dissections supports preserving level IIB lymph nodes in selective neck dissection for laryngeal squamous cell carcinoma with a clinically negative neck. ORL J Otorhinolaryngol Relat Spec 2006;68:177–84Google Scholar
26 Lim, YC, Lee, JS, Koo, BS, Choi, EC. Level IIb lymph node metastasis in laryngeal squamous cell carcinoma. Laryngoscope 2006;116:268–72CrossRefGoogle ScholarPubMed
27 Villaret, AB, Piazza, C, Peretti, G, Calabrese, L, Ansarin, M, Chiesa, F et al. Multicentric prospective study on the prevalence of sublevel IIb metastases in head and neck cancer. Arch Otolaryngol Head Neck Surg 2007;133:897–903 CrossRefGoogle ScholarPubMed
28 Santoro, R, Franchi, A, Gallo, O, Burali, G, de'Campora, E. Nodal metastases at level IIb during neck dissection for head and neck cancer: clinical and pathologic evaluation. Head Neck 2008;30:1483–7CrossRefGoogle ScholarPubMed