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Level IIb lymph node metastasis in laryngeal squamous cell carcinoma
Young Chang Lim1, Jin Seok Lee, Bon Seok Koo
1Department of Otorhinolaryngology-Head & Neck Surgery, Konkuk University College of Medicine, Seoul, Korea.
The Laryngoscope
|February 10, 2006
Summary
Preserving level IIb lymph nodes is feasible in elective neck dissection for laryngeal squamous cell carcinoma (SCC). However, thorough removal is crucial in therapeutic dissections for node-positive cases to prevent recurrence.
Area of Science:
- Otolaryngology
- Surgical Oncology
- Head and Neck Cancer Research
Background:
- Selective neck dissection for laryngeal squamous cell carcinoma (SCC) aims to minimize morbidity.
- Removal of level IIb lymph nodes, even with spinal accessory nerve preservation, can cause shoulder dysfunction.
Purpose of the Study:
- To evaluate the feasibility of preserving level IIb lymph nodes during elective and therapeutic neck dissections for laryngeal SCC.
- To determine the incidence of metastasis and recurrence in level IIb lymph nodes.
Main Methods:
- Prospective analysis of 65 patients with laryngeal SCC undergoing neck dissection.
- Separate dissection, labeling, and processing of level IIb lymph nodes.
- Evaluation of metastasis, recurrence, and risk factors (sex, age, cT/cN stage, other positive nodes).
Main Results:
- Level IIb lymph node metastasis was 1% in clinically node-negative (N0) ipsilateral necks and 37% in clinically node-positive ipsilateral necks.
- Statistically significant association between level IIb metastases and positive N stage (P<.001) and other positive lymph nodes (P=.001).
- Regional recurrence was 4% in N0 necks versus 38% in pathologically positive level IIb nodes.
Conclusions:
- Level IIb lymph node preservation is viable in elective neck dissection for laryngeal SCC.
- Complete removal of level IIb lymph nodes is recommended for therapeutic neck dissection in clinically node-positive patients to reduce recurrence.
