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Neck dissection of level IIb: is it really necessary?
Toby H Corlette1, Ian E Cole, Nader Albsoul
1Department of Otorhinolaryngology Surgery, St Vincent's Hospital, Sydney, Australia. t.corlette@garvan.org.au
The Laryngoscope
|September 9, 2005
Summary
Resecting level IIb lymph nodes is often unnecessary for upper aerodigestive tract (UADT) squamous cell carcinomas. This study found that level IIb involvement rarely occurs without level IIa involvement in N0 necks, suggesting it can be preserved.
Area of Science:
- Head and Neck Surgery
- Surgical Oncology
- Otolaryngology
Background:
- Neck dissection is a critical component of head and neck cancer treatment.
- The extent of lymph node dissection, particularly level IIb, is debated in certain head and neck squamous cell carcinoma (HNSCC) scenarios.
Purpose of the Study:
- To evaluate the necessity of resecting level IIb lymph nodes during elective and therapeutic neck dissections for HNSCC.
- To determine the rate of micrometastasis in level IIb nodes based on primary tumor site and nodal status.
Main Methods:
- Prospective case series involving 160 neck dissections in 148 patients with HNSCC.
- Level IIb lymph nodes were analyzed as separate specimens to detect micrometastases.
Main Results:
- In elective neck dissections (N0) for upper aerodigestive tract (UADT) primaries, level IIb involvement was 4.5%.
- In therapeutic neck dissections (N+) for UADT primaries, level IIb involvement was 25%.
- Level IIb was not involved unless level IIa was also involved, except for skin/parotid primaries.
Conclusions:
- Level IIb lymph node resection can be omitted in UADT primary carcinomas with nontonsillar N0 necks without compromising regional oncologic control.
- This finding may help refine surgical techniques and reduce morbidity associated with neck dissections.