Involvement of Level I Neck Lymph Nodes in Advanced Squamous Carcinoma of the Larynx

Abstract

This study was performed to evaluate the incidence of metastasis at level I in patients with squamous laryngeal cancer. One hundred consecutive patients with squamous carcinoma of the larynx were submitted to surgical treatment including radical neck dissection. The tumor stage was T3 or T4, and the neck stage was N1-N2c. Lymph node metastases were pathologically confirmed in 80 patients. Metastases were concentrated within level II in 59% of cases, level III in 17% of cases, level IV in 11% of cases, and level V in 6% of cases. Only 2 patients (2%) had detectable tumors in the lymph nodes of the submandibular triangle (level IB). This study shows that patients with laryngeal cancer rarely present metastases at the submandibular triangle, even in advanced local disease with cervical metastasis staged as N1 to N2c. Therefore, dissection of the submandibular triangle is indicated only in the presence of clinical, radiographic, or cytologic evidence of metastatic disease at level I.

A Study of Clinico-Pathological Parameters in Patients of Carcinoma Larynx

“…Dos Santos CR et al [17] found that lymph node metastasis was seen in 80 patients with advanced squamous cell carcinoma of larynx, out of which metastases were concentrated within level II in 59% of cases, level III in 17% of cases, level IV in 11% of cases and level V in 6% of cases. Most patients presented with T3 stage present in 48 (43.63%) patients.…”

Management of cervical metastasis

“…Likewise, Hamoir et al [8] proposed that it might not be necessary to dissect the superior portion of level VA in most patients with head and neck cancer. Lastly, dos Santos et al [9] showed that level I is rarely affected in carcinoma of the larynx, even at advanced stages, and thus it need not be dissected unless clinical evidence of disease is present. It is this author's opinion that continued modifications of the standardized neck dissections (ie, leaving level IIB behind in a supraomohyoid neck dissection) often make the dissection more difficult because they require well-defined anatomic planes and boundaries and increase the risk of leaving occult disease behind.…”

Occult Cervical Metastasis in Head and Neck Cancer and its Impact on Therapy

“…Oropharyngeal , hypopharyngeal and laryngeal cancers are at highest risk for nodal metastases to regions II -IV, which are adequately encompassed by a lateral (jugular) neck dissection (LND). Recent data, although retrospective in nature, show that patients with squamous cell carcinoma of the larynx rarely present metastases at the submandibular triangle, or level IB (only 2%), even in advanced local disease with cervical metastases staged as N1 -N2c (49). Two recent prospective studies support the use of LND for N0 laryngeal and hypopharyngea l cancers (6) and supraglottic and transglottic cancers (41).…”