The omission of level IIB in early oral cancers: A word of caution

Reply to Preservation of spinal accessory and level 2b–sparing neck dissection: The balance beyond oncology and functionality

“…We certainly agree with their upcoming article 2 that level 1 evidence for omitting level 2b in neck dissections does not exist and should be approached with caution. Large‐scale, retrospective studies have shown that occult level 2b metastases occur in 0% to 15% of clinically negative ipsilateral necks and 0% to 2% of contralateral necks 3‐7 .…”

Predictive modelling of level IIb lymph node metastasis in oral squamous cell carcinoma

“…Secondly, Oikawa et al noted that all subsites of oral cancer may develop retropharyngeal lymph node metastasis and that although rare, level IIb could constitute the first echelon node due to metastatic spread via the retropharyngeal lymphatic pathway 52 , 53 . Thirdly, many studies emphasizing oncologic safety without dissecting level IIb seem to have overlooked the presence of micro-metastasis (MM) or isolated tumour cells (ITC) in the pN0 nodes 54 . In a recent study, the rate of MM was as high as 9% in pN0 cases, the risk being highest in level IB and IIA 55 .…”

Preservation of spinal accessory and level 2b–sparing neck dissection: The balance beyond oncology and functionality

“…We applaud Dziegielewski et al for meticulously collating an arduous trial, pointing out subtle details and generating a high level of evidence supporting the occurrence of shoulder dysfunction in patients undergoing submuscular recess dissections 1 . Although the literature supporting the omission of level 2b is fractionated, 2 to our knowledge studies have failed to provide concrete evidence with regard to oncological safety and long‐term shoulder dysfunction in avoiding submuscular recess dissection 3,4 …”