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Is Bilateral Neck Dissection Always Necessary for Hypopharyngeal Squamous Cell Carcinoma? Risk Factors for Occult
Jiamei Wen1, Chuan Liu1, Zhihai Wang1
1Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Summary
For hypopharyngeal squamous cell carcinoma (HSCC), central tumors need bilateral neck dissection. Lateral lesions require contralateral dissection of levels II-III if ipsilateral lymph nodes are positive, T3-4, or midline crossing is present.
Area of Science:
- Head and Neck Surgery
- Oncology
- Pathology
Background:
- Hypopharyngeal squamous cell carcinoma (HSCC) presents a significant risk for occult contralateral lymph node metastasis (LNM).
- Accurate assessment of LNM risk is crucial for determining appropriate surgical management, particularly neck dissection strategies.
Purpose of the Study:
- To identify risk factors associated with occult contralateral LNM in HSCC patients.
- To provide evidence-based recommendations for optimizing neck dissection in HSCC management.
Main Methods:
- Retrospective analysis of 145 HSCC patients undergoing primary tumor resection and neck dissection.
- Collection and analysis of clinical and pathological data, including tumor characteristics and lymph node status.
- Application of univariate and multivariate logistic regression to identify risk factors for contralateral LNM.
Main Results:
- The overall rate of occult contralateral LNM was 13.24%.
- Factors influencing contralateral LNM included tumor type, ipsilateral lymph node status (cN+), tumor stage (T3-4), midline crossing, and macroscopic extranodal extension (ENE).
- Occult metastases in clinically negative contralateral necks were predominantly found in levels II and III.
Conclusions:
- Central type HSCC necessitates bilateral neck dissection.
- For lateral HSCC, contralateral dissection of levels II-III is indicated for ipsilateral cN+, T3-4 tumors, or those with midline crossing.
- Macroscopic ipsilateral ENE significantly elevates the risk of contralateral occult metastasis, suggesting intra-operative assessment is vital for guiding dissection decisions.
