Therapeutic selective neck dissection (level II–V) for node-positive hypopharyngeal carcinoma: is it oncologically safe?

Abstract

Conclusions. Our study suggests that routine level I dissection may not be necessary in the surgical management of clinically N'hypopharyngeal squamous cell carcinoma (SCC) in patients who do not have a positive lymph node in neck level I. Objective. To determine whether level I lymph node dissection can be saved in patients with clinically N'hypopharyngeal SCC. Patients and methods. Retrospective analysis of 64 consecutive clinically N'patients with untreated hypopharyngeal SCC between 1994 and 2006. Forty-seven patients underwent level I lymph node dissection and the remaining 17 did not. Forty-five of the 64 patients were followed for a minimum of 2 years, if alive, or until death. Of these 45 patients, 35 underwent ipsilateral level I dissection of the neck. Results. The incidence of occult metastases to level I was 6% (3 of 47). Six (17%) of 35 patients with level I dissection and 1 (10%) of 10 patients without level I dissection experienced regional recurrence (p0.05). The 2-year disease-specific survival in 47 patients undergoing level I neck dissection was 44% compared with 37% in 17 patients who did not undergo level I neck dissection (p 0.05).

Pattern of cervical lymph node metastasis in medial wall pyriform sinus carcinoma

“…Most studies support the suitability of selective neck dissection in levels II, III, and IV with acceptable oncologic control rates, as compared to comprehensive neck dissection for the treatment of clinically N0 hypopharyngeal SCC . Lim et al reported that the incidence of occult metastases to level I was only 6% (three of 47) in N + hypopharyngeal SCC patients, and there were no significant differences in regional recurrence between patients treated with and without level I dissection. In our study, the incidence of nodal metastasis to level I, IIb, and V lymph node in patients with hypopharyngeal SCC was 8.8% (six of 68), 8.8% (six of 68), and 5.9% (four of 68).…”

Innate Immunity and the Role of Defensins in Otitis Media

“…For instance, dsRNA stimulates human nasal fibroblasts to produce CCL5 and CXCL8 [27], and rhinovirus infection causes smooth muscle cells to produce interleukin (IL)-6 and CXCL8 [28]. In the presence of Th2 cytokines, IL-4 and IL-13, dsRNA stimulates fibroblasts to produce CCL17, further increasing the Th2 response [29]. …”

Minimally Invasive Thyroidectomy

“…Hereafter, many head and neck surgeons have made some modifi cations of this original technique, and the extent of surgical dissection has been diminished for the less surgical morbidity within the same oncologic safety (Martin et al 1951 ;Jesse et al 1978 ) . In recent years, profound comprehensions of the pathophysiology in head and neck cancers and intensive treatment experiences have drawn the alternative surgical options for the cervical lymph node metastasis, such as selective or hyperselective neck dissection in accordance with the primary tumor biology (Lim et al 2006(Lim et al , 2009Caron and Clark 2005 ) .…”