Relevance of level IIb neck dissection in oral squamous cell carcinoma

Vicente, Juan-Carlos de; Rodríguez-Santamarta, Tanía; Peña, Ignacio; Villalaín, Lucas de; Fernández-Valle, Álvaro; González-García, Manuel

doi:10.4317/medoral.20491

Cited by 11 publications

(10 citation statements)

References 28 publications

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“…17 Of the 208 necks taken up for surgery irrespective of clinical N stage, the overall incidence of level IIb positivity pathologically was 22 (10.5%) as 22 patient out of 182 patients (12%) revealed metastases at level IIB (p=0.001) , which was comparable with study by Dabholkar et al 18 who gave an incidence of level IIB metastases as 10.44% and Maher et al 19 in their study had level IIB incidence of 14.5%. However, de Vicente JC et al 1 found metastasis to Level IIB as 1.8%. Pugazhendi et al 20 found that Level II was the most involved site (63.3%) in the patients with SCC of the oral cavity.…”

Section: Discussionmentioning

confidence: 93%

“…Oral squamous cell carcinoma (OSCC) is a life-threatening disease which accounts for a burden of 32-40% of all the head and neck cancers (HNC). 1 In the Asian sub-continent oral cancer is the most common malignant tumor accounting for about one-third of all malignancies within the subcontinent and it accounts for approximately 30-40% of all cancers in India. 2 The high incidence of oral cancer and oral potentially malignant disorders in India has been linked with the habit of betel nut and tobacco chewing which is a major cause of mortality.…”

Section: Introductionmentioning

confidence: 99%

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Untitled

2020

JDHODT

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Background: To determine the overall incidence of level IIb lymph node metastases in N0/ N+ neck and whether level IIb node removal is necessary in oral squamous cell carcinoma (OSCC) patinets. Material and methods:A prospective analysis of 182 biopsy proven OSCC patients who underwent surgical excision of the primary lesion with safe margins. Based on the site, nodal involvement etc the planned neck dissection has been performed. Resected primary lesion and different levels of removed lymph nodes was marked and sent for histopathological examination. 26 (14.3%) patients underwent bilateral neck dissection and unilateral in remaining 156 patients (85.7%).Results: 22 patients in our study specifically had metastases in level IIb, representing 22 out of 182 patients (12%) and 22 out of 208 neck dissection specimens (10.5%), combining pathologically N0 necks and clinically node-positive necks. 31 patients reported with a local recurrence at 1-year follow-up period, whereas remaining 151 patients had no loco regional residual disease at 1 year follow up. All the patients with recurrent disease were provided palliative treatment. Conclusions:Our results indicate the importance of always dissecting level IIb nodes in case of high metastatic rate of patients with clinically positive neck nodes, exclusively staged as N2b or greater. However, for a therapeutic neck dissection, level IIb clearance should always be done if there are positive lymph nodes at level IIa clinically or intraoperatively on frozen section.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Untitled

2020

JDHODT

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“…Six articles [ 19 , 29 , 31 , 34 , 38 , 48 ] illustrated the characteristics of cervical skip metastasis patients, which gave details of sites, T stages, isolated IIb metastases [ 45 ], and associated metastatic lymph nodes. The incidence for skip metastasis to level IV or V was low, reaching up to 8.5% [ 29 , 31 , 34 , 48 ].…”

Section: Reviewmentioning

confidence: 99%

“…However, not all the information was complete for each study. The most common primary site for level IIb metastases was the tongue [ 22 - 24 , 45 , 47 ], reported between 2% and 28% [ 23 , 47 ]. The rate of skip metastasis among cN0 was also low, reaching 1.8% [ 19 , 29 , 31 ].…”

Section: Reviewmentioning

confidence: 99%

Prevalence of Metastasis and Involvement of Level IV and V in Oral Squamous Cell Carcinoma: A Systematic Review

AlTuwaijri¹,

Aldrees²,

Alessa³

2021

Cureus

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The occurrence of occult metastases in oral cavity squamous cell carcinoma (OSCC) to lower levels in the neck (levels IV and V) or development of skip metastases that bypass the upper neck levels (levels I to III) and go directly to level IV or V is common. This challenges the efficacy of conventional neck dissection approaches in the treatment of OSCC. Therefore, the decision to include lower levels cervical nodes during elective neck dissection of OSCC remains controversial.This systematic review was designed to assess the prevalence of level IV and/or V involvement or skip metastases in patients with the clinically negative neck (cN0) or positive (cN+) oral squamous cell carcinoma (OSCC). We searched for studies published between December 2000 and December 2020. Potentially relevant abstracts and full-text articles were screened, and data from the studies were extracted. Quality was rated using the Newcastle Ottawa Scale (NOS) criteria.In total, 802 abstracts and 227 full-text articles were screened, and 32 studies were included in this analysis. The prevalence of metastasis ranged from 1.8% to 66.0%. The incidence for skip metastasis to level IV or V was low, reaching 8.5%. Evidence favored elective neck dissection, including levels I to III, in selected patients with OSCC and patients with cN0 or cN+ neck. The literature was non-conclusive on the recommendation for inclusion of lower levels.

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“…This will invariably result in traction injury of the accessory nerve, and a subsequent neuropraxia resulting in shoulder dysfunction for very little oncological benefit in laryngeal cancer (although slightly higher metastatic rates of 3.4% are reported in the case of SCCs of the oral. 42 There also remains a consensus in addressing level IV in oral SCCs due to the presence of skip lesions, in tongue base tumors, 43 with reported rates of 2%. 44 Elective neck irradiation is as effective as elective neck dissection in the control of subclinical disease, with reported rates of 90%.…”

Section: Ijhnsmentioning

confidence: 99%

Recent Advances in the Management of Metastatic Neck Cancer

Darr¹,

Siddiq²

2017

International Journal of Head and Neck Surgery

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One of the most important prognostic factors in head and neck cancer is the presence or absence, level, and size of metastatic neck disease.Controversies in neck management still exist due to the paucity of quality clinical trials with most evidence extrapolated from retrospective studies. However, recent evidence has emerged to address some of these areas including the ideal management of the N0 neck, the role of sentinel node biopsy in occult neck disease, posttreatment surveillance with positron emission tomography and computed tomography (PET-CT) and incorporation of P16 status and extranodal extension (ENE) in the recent 8th edition of AJCC in nodal staging.This paper provides an update on the current management of metastatic neck disease in the setting of squamous cancers arising from the upper aerodigestive tract.

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Relevance of level IIb neck dissection in oral squamous cell carcinoma

Cited by 11 publications

References 28 publications

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Prevalence of Metastasis and Involvement of Level IV and V in Oral Squamous Cell Carcinoma: A Systematic Review

Recent Advances in the Management of Metastatic Neck Cancer

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