Prospective studies of neck dissection specimens support preservation of sublevel IIB for laryngeal squamous carcinoma with clinically negative neck

Abstract

A universally accepted independent adverse prognostic factor in head-and-neck squamous carcinoma is presence of cervical lymph node metastases; neck dissection for actual or potentially positive lymph nodes is often indicated. Cervical lymph node metastases can be fatal even if the primary cancer is controlled. Proper neck management in patients with laryngeal squamous carcinoma with no clinical metastases is a subject of much debate and there is no general consensus as to which type of neck dissection is appropriate. Elective neck dissection refers to dissection of cervical lymphatics in the absence of clinical metastatic disease for either staging or treatment purposes. It has been recommended for the N0 neck in patients with T2-T4 supraglottic cancers,1, 2, 3 T3-T4 glottic cancers,3, 4, 5, 6, 7, 8 T3-T4 subglottic cancers,3, 8, 9, 10 and also in patients with recurrent supraglottic and advanced glottic cancers treated with radiotherapy and salvaged with laryngectomy.11 The conventional radical neck dissection policy has been replaced by a more selective approach in the absence of clinically evident metastatic disease.12 Until recently, the procedure of choice for elective operation was modified radical neck dissection (also called functional neck dissection), preserving the sternocleidomastoid muscle, internal jugular vein, and spinal accessory nerve. A number of anatomic, radiographic, pathologic, and clinical studies have demonstrated that metastases from cancer of the larynx occur in levels II to IV, while levels I and V are rarely involved.13, 14, 15, 16 Selective neck dissection (II to IV) (SND), called lateral neck dissection, is now routinely performed for patients with laryngeal cancer in a clinically N0 neck. This surgical procedure has also been indicated recently as SND (II to IV) by the Committee for Head and Neck Surgery and Oncology of the American Academy of Otolaryngology-Head and Neck Surgery.