Level IIb Neck Dissection in Oral Cavity Cancers- When Should One Address it..?

Dabholkar, Jyoti; Kapre, Neeti Madan

doi:10.1007/s13193-015-0461-5

Cited by 10 publications

(6 citation statements)

References 17 publications

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“…It is predictable that leaving Level IIB dissected will result in a minimum amount of degenerative effect on the SAN as well as minimizes the operative time. 17 Of the 208 necks taken up for surgery irrespective of clinical N stage, the overall incidence of level IIb positivity pathologically was 22 (10.5%) as 22 patient out of 182 patients (12%) revealed metastases at level IIB (p=0.001) , which was comparable with study by Dabholkar et al 18 who gave an incidence of level IIB metastases as 10.44% and Maher et al 19 in their study had level IIB incidence of 14.5%. However, de Vicente JC et al 1 found metastasis to Level IIB as 1.8%.…”

Section: Discussionsupporting

confidence: 81%

“…23 However, for a therapeutic neck dissection, level IIb clearance should always be done if there are positive lymph nodes at level IIa clinically, or intra-operatively on frozen section. 18 As it was very troublesome to find study in published English literature pertaining to Level IIb metastasis in OSCC conducted in India, it was our sincere effort, though in a small sample size to bring out an issue, which lacks in research from this particular part of world despite having majority of patients with oral carcinomas.…”

Section: Discussionmentioning

confidence: 99%

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2020

JDHODT

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Background: To determine the overall incidence of level IIb lymph node metastases in N0/ N+ neck and whether level IIb node removal is necessary in oral squamous cell carcinoma (OSCC) patinets. Material and methods:A prospective analysis of 182 biopsy proven OSCC patients who underwent surgical excision of the primary lesion with safe margins. Based on the site, nodal involvement etc the planned neck dissection has been performed. Resected primary lesion and different levels of removed lymph nodes was marked and sent for histopathological examination. 26 (14.3%) patients underwent bilateral neck dissection and unilateral in remaining 156 patients (85.7%).Results: 22 patients in our study specifically had metastases in level IIb, representing 22 out of 182 patients (12%) and 22 out of 208 neck dissection specimens (10.5%), combining pathologically N0 necks and clinically node-positive necks. 31 patients reported with a local recurrence at 1-year follow-up period, whereas remaining 151 patients had no loco regional residual disease at 1 year follow up. All the patients with recurrent disease were provided palliative treatment. Conclusions:Our results indicate the importance of always dissecting level IIb nodes in case of high metastatic rate of patients with clinically positive neck nodes, exclusively staged as N2b or greater. However, for a therapeutic neck dissection, level IIb clearance should always be done if there are positive lymph nodes at level IIa clinically or intraoperatively on frozen section.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

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2020

JDHODT

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“…Some studies reported that the primary site for level IIb metastasis has no statistical significance. 26 , 35 But many scholars strongly recommended that dissection of level IIb in patients with tongue SCC should be incorporated into the procedures. Elsheikh et al found the incidence of metastasis at level IIb in patients with primary tumors located in the tongue to be 22%.…”

Section: Discussionmentioning

confidence: 99%

Cervical level IIb metastases in squamous cell carcinoma of the oral cavity: a systematic review and meta-analysis

Kou

Zhao

Huang

et al. 2017

OTT

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PurposeThe aim of this study was to clarify whether level IIb dissection should be performed or avoided in the treatment of oral squamous cell carcinoma by meta-analysis.Materials and methodsArticles that were published before June 2017 were searched electronically in four databases (Web of Science, PubMed, Ovid and China National Knowledge Infrastructure) without any date or language restrictions by two independent reviewers. Abstracts and full-text papers which investigated the cervical metastases to level IIb from primary head and neck cancers and were deemed potentially relevant were screened. Data were analyzed using RevMan 5.3.ResultsFour hundred and fifty-five abstracts and 129 full-text papers were screened, and 22 studies were included in the analysis. Among the 2001 patients included, 112 patients had level IIb metastases, the pooled frequency of which was 6% (95% confidence interval [CI]: 4.0–7.0). Among the 400 patients with tongue squamous cell carcinoma from 12 studies, 37 patients had level IIb metastases, the pooled incidence of which was 7% (95% CI: 5.0–10.0). Metastases to level IIb always went together with level IIa, and only three patients were found to have isolated level IIb metastases without involving the other levels.ConclusionDue to the low frequency of level IIb nodal metastases in oral squamous cell carcinoma patients and rare occurrence of isolated level IIb, level IIb dissection could be avoided when the primary lesions were in early stages (T1 and T2), with the exception of tongue cancer. It is recommended to dissect level IIb tongue cancers without considering the stages of primary lesions and the lymph nodes status. It is also suggested that level IIb dissection should be performed in patients preoperatively or intraoperatively found with multilevel neck metastasis, especially level IIa metastasis.

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“…Therefore, this region may be preserved in elective SOHND in patients with squamous cell carcinoma of the oral cavity. Dabholkar and Kapre[19] carried out a nonrandomized prospective observational study where 65 patients of oral cavity cancers were evaluated. All patients underwent Level IIb dissection.…”

Section: Discussionmentioning

confidence: 99%

Metastatic involvement of level IIb nodal station in oral squamous cell carcinoma: A clinicopathological study

Chakraborty¹,

Das

Vatsyayan

et al. 2019

Natl J Maxillofac Surg

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Background: The purpose of this study was to determine the prevalence of Level IIb metastasis in patients with oral squamous cell carcinomas (OSCCs). Materials and Methods: A total of 110 newly diagnosed oral cavity cancer patients requiring surgery as the primary modality were included in the study. Preoperative clinical examinations were done and tumor-node-metastasis staging was noted. Intraoperatively, Level IIb nodal tissue was dissected and sent separately. Results: A total of 129 neck dissections (58 SOHD, 67 modified neck dissections, and 4 radical neck dissections) were carried out in 110 patients (males = 80 and females = 30), 91 patients required unilateral neck dissection, and 19 patients required bilateral neck dissection. Out of these 129 neck dissections, only 4 (3.2%) neck dissections (in a total of 3 patients out of 110 patients) had Level IIb positive (with bilateral Level IIb involvement in one patient). Conclusions: Dissection of the Level IIb region in patients with OSCC may be required only in cases with advanced N stage, positive Level IIa lymph nodes, and extracapsular spread. Furthermore, in tongue cancers (high propensity of isolated Level II involvement), retromolar trigone, and floor of mouth cancers, routine Level IIb clearance should be considered.

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Level IIb Neck Dissection in Oral Cavity Cancers- When Should One Address it..?

Cited by 10 publications

References 17 publications

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Cervical level IIb metastases in squamous cell carcinoma of the oral cavity: a systematic review and meta-analysis

Metastatic involvement of level IIb nodal station in oral squamous cell carcinoma: A clinicopathological study

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