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Level V lymph node dissection in oral and oropharyngeal carcinoma patients with clinically node-positive neck: is it absolutely necessary?
Laryngoscope 2006; 116(7):1232-5L

Abstract

OBJECTIVES

Postoperative shoulder dysfunction has been significantly associated with any dissection of level V secondary to traction or with ischemic injury to the spinal accessory nerve. The aim of this study was to determine whether the dissection of level V lymph node pads is absolutely necessary in therapeutic neck dissection as a treatment for oral and oropharyngeal squamous cell carcinoma (OOSCC) patients with clinically N+ neck.

STUDY DESIGN

Retrospective chart review.

METHODS

We performed a retrospective analysis of 93 OOSCC patients who underwent surgical treatment of the primary lesion along with a simultaneous comprehensive neck dissection from January 1992 to December 2003. Of these, only one patient had a clinically positive neck node at level V. During the neck dissection, the contents of the level V lymph nodes were dissected, labeled, and processed separately from the remainder of the major neck dissection specimen. We studied the incidence of pathologic metastasis to level V lymph nodes. In addition, we also evaluated several potential risk factors for metastatic disease in the level V lymph nodes such as sex, age, T stage, N stage, histologic grade, and presence of other positive lymph nodes.

RESULTS

A total of 96 comprehensive neck dissections were performed in this series. The prevalence of metastases in the level V lymph nodes was 5% (5 of 93) in ipsilateral and 0% (0 of 3) in contralateral necks. One case with clinically positive node at level V had a pathologic positive node in level II, III, IV, and V. Occult metastasis rate of ipsilateral level V was 4% (4 of 92). There was a statistically significant association between level V metastases and a positive N stage above N2b (P=.01). The presence of metastasis in other multiple neck levels, particularly the combined neck levels II, III, and IV, also have a statistically significant association with level V metastasis (P=.023).

CONCLUSION

Level V lymph node pads may be preserved in modified neck dissections on OOSCC patients with clinically N+ neck below the nodal stage N2a.

Authors+Show Affiliations

Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University College of Medicine, Seoul, Korea.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

16826066

Citation

Lim, Young Chang, et al. "Level V Lymph Node Dissection in Oral and Oropharyngeal Carcinoma Patients With Clinically Node-positive Neck: Is It Absolutely Necessary?" The Laryngoscope, vol. 116, no. 7, 2006, pp. 1232-5.
Lim YC, Koo BS, Lee JS, et al. Level V lymph node dissection in oral and oropharyngeal carcinoma patients with clinically node-positive neck: is it absolutely necessary? Laryngoscope. 2006;116(7):1232-5.
Lim, Y. C., Koo, B. S., Lee, J. S., & Choi, E. C. (2006). Level V lymph node dissection in oral and oropharyngeal carcinoma patients with clinically node-positive neck: is it absolutely necessary? The Laryngoscope, 116(7), pp. 1232-5.
Lim YC, et al. Level V Lymph Node Dissection in Oral and Oropharyngeal Carcinoma Patients With Clinically Node-positive Neck: Is It Absolutely Necessary. Laryngoscope. 2006;116(7):1232-5. PubMed PMID: 16826066.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Level V lymph node dissection in oral and oropharyngeal carcinoma patients with clinically node-positive neck: is it absolutely necessary? AU - Lim,Young Chang, AU - Koo,Bon Seok, AU - Lee,Jin Seok, AU - Choi,Eun Chang, PY - 2006/7/11/pubmed PY - 2006/8/19/medline PY - 2006/7/11/entrez SP - 1232 EP - 5 JF - The Laryngoscope JO - Laryngoscope VL - 116 IS - 7 N2 - OBJECTIVES: Postoperative shoulder dysfunction has been significantly associated with any dissection of level V secondary to traction or with ischemic injury to the spinal accessory nerve. The aim of this study was to determine whether the dissection of level V lymph node pads is absolutely necessary in therapeutic neck dissection as a treatment for oral and oropharyngeal squamous cell carcinoma (OOSCC) patients with clinically N+ neck. STUDY DESIGN: Retrospective chart review. METHODS: We performed a retrospective analysis of 93 OOSCC patients who underwent surgical treatment of the primary lesion along with a simultaneous comprehensive neck dissection from January 1992 to December 2003. Of these, only one patient had a clinically positive neck node at level V. During the neck dissection, the contents of the level V lymph nodes were dissected, labeled, and processed separately from the remainder of the major neck dissection specimen. We studied the incidence of pathologic metastasis to level V lymph nodes. In addition, we also evaluated several potential risk factors for metastatic disease in the level V lymph nodes such as sex, age, T stage, N stage, histologic grade, and presence of other positive lymph nodes. RESULTS: A total of 96 comprehensive neck dissections were performed in this series. The prevalence of metastases in the level V lymph nodes was 5% (5 of 93) in ipsilateral and 0% (0 of 3) in contralateral necks. One case with clinically positive node at level V had a pathologic positive node in level II, III, IV, and V. Occult metastasis rate of ipsilateral level V was 4% (4 of 92). There was a statistically significant association between level V metastases and a positive N stage above N2b (P=.01). The presence of metastasis in other multiple neck levels, particularly the combined neck levels II, III, and IV, also have a statistically significant association with level V metastasis (P=.023). CONCLUSION: Level V lymph node pads may be preserved in modified neck dissections on OOSCC patients with clinically N+ neck below the nodal stage N2a. SN - 0023-852X UR - https://www.unboundmedicine.com/medline/citation/16826066/Level_V_lymph_node_dissection_in_oral_and_oropharyngeal_carcinoma_patients_with_clinically_node_positive_neck:_is_it_absolutely_necessary L2 - https://doi.org/10.1097/01.mlg.0000224363.04459.8b DB - PRIME DP - Unbound Medicine ER -