Nodal metastases at level IIb during neck dissection for head and neck cancer: Clinical and pathologic evaluation

Santoro, Roberto; Franchi, Alessandro; Gallo, Oreste; Burali, Giulia; Campora, E. De

doi:10.1002/hed.20907

Cited by 44 publications

(33 citation statements)

References 21 publications

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“…Radical neck dissection or modified radical neck dissection is the surgical treatment of choice in patients with carcinoma of the hypopharynx with clinical N+ neck [30]. On the other hand, the incidence of occult nodal metastasis in patients with hypopharyngeal cancer is found to be more than 20% [31]. The lack of investigation modality with satisfactory sensitivity and specificity to detect such microscopic metastasis, together with the apparently poor locoregional disease control as well as distant metastasis with wait-and-see strategy makes prophylactic neck dissection a logical option for patients with clinically N0 neck [32].…”

Section: Management Of the Neckmentioning

confidence: 98%

Current management strategy of hypopharyngeal carcinoma

2013

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Section: Management Of the Neckmentioning

confidence: 98%

Current management strategy of hypopharyngeal carcinoma

2013

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“…11,12 Furthermore, to minimise post-operative morbidity, super-selective dissection of sublevels IIa-III has recently been proposed because of the rare involvement of sublevel IIb and level IV in clinically staged N 0 laryngeal carcinomas. 16,17 In a previously irradiated neck, however, the usual regional lymphatic pathway for both the larynx and neck may have been extensively modified by radiation-induced sclerosis of the lymphatic vessels. Hence, a post-RT recurrent laryngeal tumour could spread to lymph nodes beyond the original predicted pathway.…”

Section: Introductionmentioning

confidence: 99%

Is elective neck dissection necessary in cases of laryngeal recurrence after previous radiotherapy for early glottic cancer?

et al. 2014

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Objectives: To assess the clinical utility of elective neck dissection in node-negative recurrent laryngeal carcinoma after curative radiotherapy for initial early glottic cancer.Methods: A retrospective review was undertaken of 110 consecutive early glottic cancer patients who developed laryngeal recurrence after radiotherapy (34 recurrent T 1 , 36 recurrent T 2 , 29 recurrent T 3 and 11 recurrent T 4a ) and received salvage laryngeal surgery between 1995 and 2005.Results: Six patients presented with laryngeal and neck recurrence and underwent salvage laryngectomy with therapeutic neck dissection, 97 patients with recurrent node-negative tumours underwent salvage laryngeal surgery without neck dissection and only 7 underwent elective neck dissection. No occult positive lymph nodes were documented in neck dissection specimens. During follow up, only three patients with neck failure were recorded, all in the group without neck dissection. There was no significant association between the irradiation field (larynx plus neck vs larynx) and the development of regional failure. A higher rate of post-operative pharyngocutaneous fistula development occurred in the neck dissection group than in the group without neck dissection (57.2 per cent vs 13.4 per cent, p = 0.01). Multivariate logistic regression analysis showed that early (recurrent tumour-positive, node-positive) or delayed (recurrent tumour-positive, node-negative) neck relapse was not significantly related to the stage of the initial tumour or the recurrent tumour. An age of less than 60 years was significantly associated with early neck failure (recurrent tumour-positive, node-positive).Conclusion: Owing to the low occult neck disease rate and high post-operative fistula rate, elective neck dissection is not recommended for recurrent node-negative laryngeal tumours after radiation therapy if the initial tumour was an early glottic cancer.

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“…Level IIa were found to be positive for lymph nodes metastasis for all patients of positive level IIb. 8 In Talmi et al, 15 four out of 102 neck dissections had level IIb lymph nodes metastasis. All of the four neck dissections had level IIa lymph node metastasis and were advanced pathological N staging.…”

Section: Discussionmentioning

confidence: 98%

“…That is why obtaining frozen section biopsy intraoperatively is highly recommended to identify these factors. 4 Other study 8 found it to be inaccurate to perform frozen section biopsy to identify level IIa lymph nodes occult metastasis. One study 14 suggests removing this level in clinically N+ necks, but mostly avoided in clinical N0.…”

Section: Discussionmentioning

confidence: 98%

“…5,6 However, in clinically negative neck lymph nodes, many authors do not advocate SND. 4,7,8 One reason for that is, the incidence of metastases to level IIb lymph nodes is low; therefore, dissection of this level may be unnecessary. 8 Furthermore, additional operating time may be required since the operation of this area involves ijhns original article 1,3-7 Resident, 2 Consultant 1-7 Department of Otolaryngology, Head and Neck Surgery King Saud University, Saudi Arabia many delicate structures as SAN, which lead to increase morbidity like shoulder dysfunction postoperatively.…”

Section: Introductionmentioning

confidence: 99%

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Incidence of Lymphatic Metastasis to Neck Nodes Level IIb in Neck Dissection for Head and Neck Cancers: A Retrospective Study

Zahrani¹,

Al‐Qahtani²,

Alshahrani³

et al. 2014

International Journal of Head and Neck Surgery

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Introduction: Selective neck dissection (SND) is performed to prevent head and neck cancers metastasis. We tried to determine the incidence of level IIb lymph nodes metastasis and it is associations in head and neck cancers for selection of patients requiring SND. Materials and methods:A retrospective study was conducted on 57 patients who underwent surgical removal of the head and neck tumor by 84 neck dissections. Fisher exact test was used to measure the association between positive IIb nodes and the other variables.Results: Nine (15.8%) of 57 patients showed level IIb lymph nodes metastasis comprising 10.71% of the 84 neck dissections. Six (66.66%) were associated with oral cavity cancers, 8 (88.9%) with squamous cell carcinoma (SCC), 6 (66.66%) with T4 tumor. Five (55.6%) were N2b, and 7 (77.8%) were found in N+ necks. All (100%) positive IIb nodes were associated with metastatic level IIa. Significant associations were found bet ween positive IIb nodes and N2b (p = 0.005), clinically N+ necks (p = 0.005) and IIa (p < 0.01).

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Nodal metastases at level IIb during neck dissection for head and neck cancer: Clinical and pathologic evaluation

Abstract: The incidence of metastases at level IIb is low, also in the N+ necks, therefore dissection of this level could be unnecessary in N0 necks. Furthermore, an interesting statistical association between the presence of metastases at level IIb and at level IIa was recorded.

Cited by 44 publications

References 21 publications

Current management strategy of hypopharyngeal carcinoma

Current management strategy of hypopharyngeal carcinoma

Is elective neck dissection necessary in cases of laryngeal recurrence after previous radiotherapy for early glottic cancer?

Incidence of Lymphatic Metastasis to Neck Nodes Level IIb in Neck Dissection for Head and Neck Cancers: A Retrospective Study

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