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American Head & Neck Society
July 21-25, 2012
Metro Toronto Convention Centre
Toronto, ON, Canada


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NECESSITY OF NECK DISSECTION AT LEVEL IIB FOR LARYNGEAL AND HYPOPHARYNGEAL CANCER

Presentation: P104
Topic: Management of the Neck
Type: Poster
Date: Sunday - Tuesday, July 22 - 24, 2012
Session: Designated Poster viewing times
Authors: AKIHIRO SAKAI, MD, Kenji Okami, MD PhD, Koji Ebisumoto, MD, Ryosuke Sugimoto, MD, Masahiro Iida, MD PhD
Institution(s): Department of Otolaryngology Tokai University

Objectives
Selective neck dissection (SND) of level II-IV is indicated for N0 neck of Laryngeal cancer (LC) and Hypopharyngeal cancer (HPC). However, in spite of preserving the spinal accessory nerve, postoperative shoulder dysfunction commonly occurs. Morbidity of the shoulder function after neck dissection has a profound impact on the quality of life of patients. Several studies have described the better shoulder function after SND preserving level IIb. Level IIb lymph node metastases are very rare in LC. However, there is an only small number of reports examining level IIb LN metastasis for HPC. The aim of this study is to determine whether the dissection of level IIb is necessary in elective neck dissections (END) or therapeutic neck dissections (TND) for LC and HPC.
Patients and Method
This retrospective study was based on a medical review between 2008 and 2010. Sixty patients with LC and HPC who underwent neck dissection were analyzed. Dissection levels for END were level II-IV and that for TND were level II-V. The incidence of pathological metastasis to level IIb lymph nodes and the presence of other positive lymph nodes according to elective or therapeutic neck dissections were examined. In addition, regional recurrences in this area and other clinical factors such as TN stage and primary site were also analyzed.
Results
A total of 89 neck dissections were analyzed in this study. In LC, 12 dissections were TND and 26 were END. The incidence of metastases in the level IIb lymph nodes was 8% (1/12) in TND and 0% (0/26) in END. In HPC, 30 dissections were TND and 21 were END. The incidence of metastases in the level IIb was 17% (5/30) in TND and 0% (0/21) in END. All metastasis were existed in the ipsilateral necks. All patients who had positive lymph nodes at level IIb also had a positive neck node at other area. The regional recurrences were seen in 4 patients (4/60: 7%) with HPC only. Of the 4 regional recurrences, 2 cases had relapse in the ipsilateral neck, and 2 cases in the contralateral neck. There was no significant correlation with other clinical factors.
Conclusion
In this study, all cases of the metastases at level IIb lymph node were observed in TND regardless of primary lesion. There were no metastasis of level IIb in END with LC and HPC. Our results and other reports suggest that level IIb lymph node could be preserved in END for LC and may be preserved in END for HPC.


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