Abstract
Level II–IV selective neck dissection, often performed bilaterally, has become the procedure of choice for elective dissection of the clinically negative (N0) neck in the treatment of laryngeal cancer. The most significant morbidity of this procedure is dysfunction of the accessory nerve, incurred by the necessity of mobilization and retraction of the nerve in order to remove the contents of sublevel IIB. Other morbidity includes possible injury to the phrenic nerve and chylous fistula. These complications are associated with the dissection of level IV. A number of prospective multi-institutional studies of the distribution of cervical lymph node metastases in the neck indicate that lymph nodes in sublevel IIB and level IV are rarely involved in cases of laryngeal cancer with N0 neck. Information was obtained by the study of neck dissection specimens by conventional light microscopy, and by molecular analysis of the specimens. Molecular analysis reveals a significant number of metastases that are not discovered by light microscopy, and is thus essential for this type of evaluation. The authors conclude that these preliminary studies indicate that it is safe and appropriate to eliminate dissection of sublevel IIB and level IV from the elective neck dissection performed for laryngeal cancer with N0 neck. This practice will reduce both operating time and morbidity, particularly accessory nerve dysfunction, without compromising the oncologic result. Further prospective studies are needed to confirm these conclusions.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Robbins KT, Clayman G, Levine PA, Medina J, Sessions R, Shaha A, Som P, Wolf GT (2002) Neck dissection classification update. Revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology–Head and Neck Surgery. Arch Otolaryngol Head Neck Surg 128:751–758
Laverick S, Lowe D, Brown JS, Vaughan ED, Rogers SN (2004) The impact of neck dissection on health-related quality of life. Arch Otolaryngol Head Neck Surg 130:149–154
Terrell JE, Welsh DE, Bradford CR, Chepeha DB, Esclamado RM, Hogikyan ND, Wolf GT (2000) Pain, quality of life, and spinal accessory nerve status after neck dissection. Laryngoscope 110:620–626
Köybaşioğlu A, Tokçaer AB, Inal E, Uslu S, Koçak T, Ural A (2006) Accessory nerve function in lateral selective neck dissection with undissected level IIB. ORL J Otorhinolaryngol Relat Spec 68:88–92
Elsheikh MN, Rinaldo A, Hamakawa H, Mahfouz ME, Rodrigo JP, Brennan J, Devaney KO, Grandis JR, Ferlito A (2006) Importance of molecular analysis in detecting cervical lymph node metastasis in head and neck squamous cell carcinoma. Head Neck 28:842–849
Yamazaki Y, Chiba I, Hirai A, Satoh C, Sakakibara N, Notani K, Iizuka T, Totsuka Y (2005) Clinical value of genetically diagnosed lymph node micrometastasis for patients with oral squamous cell carcinoma. Head Neck 27:676–681
Hamakawa H, Fukizumi M, Bao Y, Sumida T, Onishi A, Tanioka H, Sato H, Yumoto E (1999) Genetic diagnosis of micrometastasis based on SCC antigen mRNA in cervical lymph nodes of head and neck cancer. Clin Exp Metastasis 17:593–599
Yoshioka S, Fujiwara Y, Sugita Y, Okada Y, Yano M, Tamura S, Yasuda T, Takiguchi S, Shiozaki H, Monden M (2002) Real-time rapid reverse transcriptase-polymerase chain reaction for intraoperative diagnosis of lymph node micrometastasis: clinical application for cervical lymph node dissection in esophageal cancers. Surgery 132:34–40
Shores CG, Yin X, Funkhouser W, Yarbrough W (2004) Clinical evaluation of a new molecular method for detection of micrometastases in head and neck squamous cell carcinoma. Arch Otolaryngol Head Neck Surg 130:937–942
Hamakawa H, Onishi A, Sumida T, Terakado N, Hino S, Nakashiro KI, Shintani S (2004) Intraoperative real-time genetic diagnosis for sentinel node navigation surgery. Int J Oral Maxillofac Surg 33:670–675
Becker MT, Shores CG, Yu KK, Yarbrough WG (2004) Molecular assay to detect metastatic head and neck squamous cell carcinoma. Arch Otolaryngol Head Neck Surg 130:21–27
Nieuwenhuis EJ, Jaspars LH, Castelijns JA, Bakker B, Wishaupt RG, Denkers F, Leemans CR, Snow GB, Brakenhoff RH (2003) Quantitative molecular detection of minimal residual head and neck cancer in lymph node aspirates. Clin Cancer Res 9:755–761
Ferris RL, Xi L, Raja S, Hunt JL, Wang J, Gooding WE, Kelly L, Ching J, Luketich JD, Godfrey TE (2005) Molecular staging of cervical lymph nodes in squamous cell carcinoma of the head and neck. Cancer Res 65:2147–2156
Brennan JA, Mao L, Hruban RH, Boyle JO, Eby YJ, Koch WM, Goodman SN, Sidransky D (1995) Molecular assessment of histopathological staging in squamous-cell carcinoma of the head and neck. N Engl J Med 332:429–435
Rinaldo A, Elsheikh MN, Ferlito A, Chone CT, Coskun HH, Köybaşioğlu A, Esclamado RM, Corlette TH, Talmi YP (2006) Prospective studies of neck dissection specimens support preservation of sublevel IIB for laryngeal squamous carcinoma with clinically negative neck. J Am Coll Surg 202:967–970
Köybasioğlu A, Uslu S, Yilmaz M, Inal E, Ileri F, Asal K (2002) Lymphatic metastasis to the supraretrospinal recess in laryngeal squamous cell carcinoma. Ann Otol Rhinol Laryngol 111:96–99
Aydogan LB, Aydogan FK, Uguz A, Soylu L, Tuncer U, Kiroglu MM (2004) Levels IIB and IV involvement in laryngeal carcinoma. Final Program and Abstract Book, 6th Int Conf Head Neck Cancer, Washington, DC: 111 (Poster Session 1, p1–195)
Coskun HH, Erisen L, Basut O (2004) Selective neck dissection for clinically N0 neck in laryngeal cancer: is dissection of level IIb necessary? Otolaryngol Head Neck Surg 131:655–659
Lim YC, Lee JS, Koo BS, Choi EC (2006) Level IIb lymph node metastasis in laryngeal squamous cell carcinoma. Laryngoscope 116:268–272
Elsheikh MN, Mahfouz ME, Salim EI, Elsheikh EA (2006) Molecular assessment of neck dissections supports preserving level IIB lymph nodes in selective neck dissection for laryngeal squamous cell carcinoma with a clinically negative neck. ORL J Otorhinolaryngol Relat Spec 68:177–184
Lim YC, Choi EC, Lee JS, Koo BS, Song MH, Shin HA (2006) Is dissection of level IV absolutely necessary in elective lateral neck dissection for clinically N0 laryngeal carcinoma? Oral Oncol 42:102–107
Elsheikh MN, Ferlito A, Rinaldo A, Shaha AR, Khafif A, Coþkun HH, Kowalski LP, Medina JE (2006) Do pathologic and molecular analyses of neck dissection specimens justify the preservation of level IV for laryngeal squamous carcinoma with clinically negative neck? J Am Coll Surg 202:320–323
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ferlito, A., Silver, C.E., Suárez, C. et al. Preliminary multi-institutional prospective pathologic and molecular studies support preservation of sublevel IIB and level IV for laryngeal squamous carcinoma with clinically negative neck. Eur Arch Otorhinolaryngol 264, 111–114 (2007). https://doi.org/10.1007/s00405-006-0209-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-006-0209-5