Rational choice of neck dissection in clinically N0 patients with supraglottic cancer

Abstract

Background: The mainstay treatment of the neck for clinically negative neck (cN0) supraglottic laryngeal carcinoma (SGLC) is neck dissection. However, the optimal extent remains controversial. This study's purpose is to determine whether ipsilateral level II-III neck dissection is appropriate for cN0SGLC patients.Methods: The records of 220 consecutive untreated cN0SGLC patients were retrospectively reviewed. Relevant factors related to occult and contralateral neck metastasis were analyzed and the distribution of metastasis was described. Results: Seventy-seven and 143 patients underwent unilateral and bilateral neck dissection, respectively. The rate of occult neck metastases was 21.4%. The histologic differentiation was an independent risk factor for occult neck metastasis. In the bilateral neck dissection group, the incidence of contralateral neck metastasis of patients with noncentral tumors was 0.7%. Moreover, only 1.7% of patients had positive nodes at level IV, and no isolated nodal metastases existed in level IV. Conclusion: Ipsilateral level II-III neck dissection is feasible for patients with noncentral cN0SGLC. K E Y W O R D Sneck dissection, occult nodal metastasis, supraglottic cancer

Patterns of cervical lymph node metastasis in supraglottic laryngeal cancer and therapeutic implications of surgical staging of the neck

“…In our study, 17% (n = 5/30) of patients across all stages who were clinically staged N0 had positive lymph nodes on final pathological assessment, i.e., occult nodal metastases. These numbers are comparable, or slightly lower than those reported by other authors, who found occult metastases in up to 30% of patients with clinical N0 status at the time of surgery [16][17][18]. Our data suggest a positive correlation between the rate of occult nodal metastasis and the size of the primary tumor: Four of the five patients with occult nodal metastasis had advanced stage local disease.…”

The survival benefit of lymph node dissection in resected T1–2, cN0 supraglottic cancer: A population‐based propensity score matching analysis

“…Moreover, our study suggested that LND should be conducted to achieve greater survival benefits in the grade 3–4 patient subgroup. Accordingly, a study reviewed 220 untreated cN0 SC patients and concluded that the histologic differentiation was associated with occult lymph node metastases; worse pathological lesion differentiation was associated with a higher risk of occult neck metastasis 18 . Additionally, we found a survival benefit with LND in the subgroup of patients who were male, white race, married, with squamous carcinoma, underwent endoscopic surgery, and not a pair laterality.…”

“…Guney et al 6 found that 23% of occult neck disease occurred on the side ipsilateral to the primary lesion in 39 patients with T1‐2N0 SC. Zhang et al 18 reported 13.0% and 20.5% occult neck metastasis rates for T1 and T2 lesions in cN0 SC, respectively. Yüce et al 5 reported a 3.1% occult metastasis rate in patients without epilarynx involvement and a rate of 20.5% in patients with epilarynx involvement.…”

Patterns of Cervical Lymph Node Metastasis in Locally Advanced Supraglottic Squamous Cell Carcinoma: Implications for Neck CTV Delineation

“…The pathways of IM and CM were shown as follows (Figure 3). In type C (n = 68), the LMRs at left neck levels II, III, and IV were 16.2% (11), 20.6% (14), and 2.9% (2), respectively, and 16.2% (11), 16.2% (11), and 1.5% (1) for the right neck. Twenty-five patients had level VIb dissection.…”

“…According to the location of primary lesions, the patients were defined as the following types: type A, unilateral without midline involvement; type B, unilateral with crossing the midline; type C, central. Contralateral metastasis (CM) was analyzed only in types A and B. LNM of the left and right neck side was described in type C (Figure 1) (14).…”