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Lymph node metastasis in level IIb in oropharyngeal squamous cell carcinoma: a multicentric, longitudinal, retrospective analysis

  • Head and Neck
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A Correction to this article was published on 02 December 2022

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Abstract

Introduction

Nowadays, 70% of patients in Europe and the USA are affected by a p16 + , potentially HPV driven oropharyngeal squamous cell carcinoma. However, despite the improved survival rate in this group, the quality-of-life remains low in cases which neck dissection took place. In this vein, in recent years, some surgeons have considered to avoid dissection of level IIB, proposing a supra-selective non-IIb neck dissection.

Materials and methods

A retrospective, longitudinal, multicentric study was conducted, including patients with pathologically confirmed primary HPV + or HPV − OPSCC who went through surgical treatment for the primary lesion and neck dissection.

Results

141 patients were included. Among them, 99 (70.2%) were male and 42 (29.8%) were female. The mean age was 62 ± 9 years (range 36–81). The most frequent anatomical location was the tonsil in 63 (44.7%) of patients. The most common approach was the classic transoral oropharyngectomy in 51 (36.2%) patients. Immunohistochemistry for p16 was positive in 62 (44%) patients. One-hundred and five (74.5%) patients received a unilateral ND, and a 36 (25.5%) a bilateral ND. Of those, a 12.8% (18/141) of patients were level IIb LN + . According to our results, level IIb ND should be considered in patients underwent therapeutic ND with positive LN metastasis in level IIa (OR = 9.83; 95% CI 3.463–27.917) or III (OR = 6.25; 95% CI 2.158–18.143), advanced (T3/T4) oropharyngeal primary tumors (OR = 3.38; 95% CI 1.366–8.405), and patients with ENE (OR = 6.56; 95% CI 2.182–19.770), regardless of p16 status.

Conclusions

According to our results, level IIb ND should be considered in patients who underwent therapeutic ND with positive LN metastasis in level IIa or III, advanced oropharyngeal primary tumors, and patients with ENE, independently of p16 status. Prospective data are necessary to definitively ensure the safety of omitting ipsilateral or contralateral level IIb ND in cN − patients with early stage disease.

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Authors and Affiliations

  1. Otorhinolaryngology-Head and Neck Surgery Department, Hospital Universitario Donostia, Calle Doctor Begiristain #1, CP 20014, San Sebastian, Guipuzkoa, Basque Country, Spain

    Carlos Miguel Chiesa-Estomba, Juan David Urazan, José Ángel González-García & Jon Alexander Sistiaga-Suarez

  2. Otolaryngology and Head-Neck Surgery Unit, Department of Head-Neck Surgeries, Morgagni Pierantoni Hospital, Azienda USL Della Romagna, Forlì, Italy

    Giovanni Cammaroto & Giuseppe Meccariello

  3. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy

    Giuditta Mannelli

  4. Otorhinolaryngology-Head and Neck Surgery, Department of Surgery, University of Verona, Verona, Italy

    Gabriele Molteni & Virginia Dallari

  5. Department of Otolaryngology, Elsan Hospital, Paris, France

    Jerome R. Lechien

  6. Otorhinolaryngology-Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), 15006, Galicia, A Coruña, Spain

    Miguel Mayo-Yanez

  7. Otorhinolaryngology-Head and Neck Surgery Department, Hospital Universitario de Jerez, Jerez de La Frontera, Cádiz, Spain

    Manuel Tucciarone

  8. Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de L’Université de Montréal, Montreal, Canada

    Tareck Ayad

  9. Head and Neck Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France

    Carlos Miguel Chiesa-Estomba, Giovanni Cammaroto, Giuditta Mannelli, Gabriele Molteni, Jerome R. Lechien, Miguel Mayo-Yanez, Manuel Tucciarone & Tareck Ayad

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  1. Carlos Miguel Chiesa-Estomba
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Correspondence to Carlos Miguel Chiesa-Estomba.

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The original online version of this article was revised due to the first and last names were swapped for the following authors “Giovanni Cammaroto, Giuditta Mannelli, Gabriele Molteni, Virginia Dallari, Jerome R Lechien, Manuel Tucciarone, Tareck Ayad, Giuseppe Meccariello” and corrected in this version

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Chiesa-Estomba, C.M., Urazan, J.D., Cammaroto, G. et al. Lymph node metastasis in level IIb in oropharyngeal squamous cell carcinoma: a multicentric, longitudinal, retrospective analysis. Eur Arch Otorhinolaryngol 280, 869–876 (2023). https://doi.org/10.1007/s00405-022-07647-6

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