The Necessity of Dissection of Level IIb in Laryngeal Squamous Cell Carcinoma

Abstract

Objective. Head and neck squamous cell carcinomas readily metastasize to adjacent cervical lymph nodes. This is seen frequently in laryngeal squamous cell carcinoma (LSCC), and neck dissection may be performed in addition to excision of the primary lesion. The aim of this study was to define the frequency of level IIb metastasis to the lymph nodes in patients who underwent selective neck dissection because of LSCC. Study Design and Setting. Cross-sectional study with planned data collection in a tertiary referral hospital. Subjects and Methods. Eighty-one patients diagnosed with LSCC were accepted into the study. One hundred forty-eight neck dissection specimens were examined histopathologically, and those with level IIb metastasis were identified. The frequency of level IIb metastasis was evaluated in accordance with the primary tumor site, clinical N stage, central tumor presence, and T stage. Results. Forty-seven of 81 patients were clinically N−, and 34 patients were clinically N+. Level IIb metastasis was seen in 5 (6%) of 81 patients, representing 5 of 148 neck dissection specimens. Two of these 5 patients were clinically N+ (6%), and 3 were clinically N− (6%). The relationship between level IIb metastasis and clinical N stage was not statistically significant ( P ≥ .05). Likewise, no statistically significant relationships between the other parameters and level IIb involvement were found. Conclusion. Level IIb nodal involvement is very rare in LSCC. Therefore, the area can generally be preserved in elective neck dissection to lessen morbidity and, specifically, to avoid damaging the function of the spinal accessory nerve.