Is dissection of levels 4 and 5 justified for cN0 laryngeal and hypopharyngeal cancer?

Abstract

The prevalence of level 4 occult metastases was 3.4%; 1.5% of them were isolated to level 4. We observed regional recurrence in 5.6% of the necks. No case of metastasis or regional relapse was observed in level 5.

Incidence of Occult Lymph Node Metastasis in Primary Larynx Squamous Cell Carcinoma, by Subsite, T Classification and Neck Level: A Systematic Review

“…All the studies were case series, except the case control study by Djordjevic et al [45]. Eight studies were prospective [20,25,27,29,36,39,42,45]; fifteen studies analyzed the larynx without specification of occult metastasis by subsite [10,13,15,20,[24][25][26][27]29,34,37,39,40,43,46]; nineteen analyzed supraglottic tumors [10,12,14,16,18,19,22,23,28,[30][31][32][33]35,36,38,42,44,45]; and six, glottic tumors [10,17,21,23,31,41]. Katilmis et al included a small number of hypopharynx tumors (13/213)…”

“…Other weaknesses are related to patient selection in individual studies. Furthermore, one study included a small number of patients with hypopharynx tumors, but the corresponding effect on the calculation of the pooled incidence is minimal [34]. Finally, during the more than 50-year period covered by our analysis, pre-therapeutic diagnostic procedures and protocols have changed dramatically, and thus the accuracy of the assessment of the neck stage prior to treatment.…”

“…All studies, except two [34,39], reported an overall rate of occult metastasis of 18.7% (711/3803 patients). The pooled incidence was not calculated due to the expected clinical and statistical heterogeneity by subsites.…”

“…The presence of occult lymph node metastasis at level I was reported in only two studies [10,13], but in both there was no information about involvement of sublevels IA or IB. Level II involvement was reported in eleven studies [10,13,24,27,29,[32][33][34][44][45][46], level III in eleven studies, [10,13,24,27,29,[32][33][34][44][45][46], level IV in seventeen studies [10,13,20,[24][25][26][27]29,[32][33][34]37,39,[43][44][45][46] and level V in five studies [10,13,20,24,34]. Figures S4, S5 and Table S1 shows data about the studies and pooled incidence and…”

“…The studies of Candela et al [13] and Djordjevic et al [45] explain the statistical heterogeneity for the level III analysis and the study of Spriano et al [24] explains the statistical heterogeneity for the level V analysis. Fifteen studies assessed larynx tumors without specifying the outcomes by subsite (NOS) [10,13,15,20,[24][25][26][27]29,34,37,39,40,43,46]. Patients had tumors classified as supraglottic in 26.1%, transglottic in 24.8% and glottic/other site in 21.0% of the cases.…”