Abstract
Background
Cervical nodal metastasis is the most important prognostic factor in patients with head and neck cancers. Unfortunately, nodal dissection at level IIb carries a risk of damage to the spinal accessory nerve. We aimed to determine the prevalence of level IIb metastasis and the relevance of nodal dissection at level IIb in patients with head and neck squamous cell carcinomas.Methods
During neck dissection, level IIb lymph nodes obtained from 181 patients with head and neck squamous cell carcinomas were removed, processed, and histopathologically examined. All specimens were divided into two groups according to the side (affected and unaffected sides). The number of dissected lymph nodes and prevalence of level IIb metastasis in each group were then determined and compared according to the preoperative clinical N stage (cN0 and cN+).Results
The study included 158 men and 23 women with a median age of 65 years (range, 17-89 years). The prevalence of pathologically confirmed level IIb metastasis was 0% for clinically node-negative (cN0) necks on the unaffected side and 10.34% for clinically node-positive necks (cN+), with an overall prevalence of 2.4%. There was a significant association between clinically determined and pathologically confirmed node negativity at level IIb.Conclusion
Our findings suggest that level IIb neck dissection in patients with head and neck squamous cell carcinomas may be required only if preoperative examination reveals multilevel or level IIa metastasis or suspicious level IIb metastasis.References
Articles referenced by this article (19)
Surgical consensus guidelines on sentinel node biopsy (SNB) in patients with oral cancer.
Head Neck, (8):2655-2664 2019
MED: 30896058
How to release neck dissections: Role of the triangle between the spinal accessory nerve and the internal jugular vein.
Eur Ann Otorhinolaryngol Head Neck Dis, (3):201-203 2016
MED: 27840043
When should a level IIB neck dissection be performed in treatment of head and neck squamous cell carcinoma?
Laryngoscope, (8):1739-1740 2017
MED: 29238997
Results of a randomized controlled trial of level IIb preserving neck dissection in clinically node-negative squamous carcinoma of the oral cavity.
World J Surg Oncol, (1):219 2018
MED: 30409212
Level IIb lymph node metastasis in laryngeal squamous cell carcinoma.
Laryngoscope, (2):268-272 2006
MED: 16467717
The 11th nerve syndrome. Accessory nerve palsy or adhesive capsulitis?
Arch Otolaryngol Head Neck Surg, (2):215-220 1993
MED: 8427686
Efficacy of selective neck dissection: a review of 503 cases of elective and therapeutic treatment of the neck in squamous cell carcinoma of the upper aerodigestive tract.
Otolaryngol Head Neck Surg, (2):180-187 2001
MED: 11226954
The evolving role of selective neck dissection for head and neck squamous cell carcinoma.
Eur Arch Otorhinolaryngol, (4):1195-1202 2012
MED: 22903756
Dissection of the submuscular recess (sublevel IIb) in squamous cell cancer of the upper aerodigestive tract: prospective study and systematic review of the literature.
Head Neck, (2):194-200 2008
MED: 17712854
Posterior triangle metastases of squamous cell carcinoma of the upper aerodigestive tract.
Am J Surg, (4):395-398 1993
MED: 8214300
Show 9 more references (10 of 19)
Citations & impact
Impact metrics
Citations of article over time
Smart citations by scite.ai
Explore citation contexts and check if this article has been
supported or disputed.
https://scite.ai/reports/10.1007/s00268-019-05147-z
Article citations
Primary Tumour Characteristics Poorly Correlate with Extracapsular Spread and Cervical Sublevel IIb Metastasis in Patients with Oral Squamous Cell Carcinoma and Clinically N0 Neck: A Retrospective Study.
Ann Maxillofac Surg, 11(2):274-279, 01 Jul 2021
Cited by: 1 article | PMID: 35265498 | PMCID: PMC8848704
Rational surgical neck management in total laryngectomy for advanced stage laryngeal squamous cell carcinomas.
J Cancer Res Clin Oncol, 147(2):549-559, 18 Aug 2020
Cited by: 1 article | PMID: 32809056 | PMCID: PMC7817600
Letter to the Editor: Relevance of Level IIb Neck Dissection in Patients with Head and Neck Squamous Cell Carcinomas.
World J Surg, 44(5):1691-1692, 01 May 2020
Cited by: 0 articles | PMID: 32107594
Authors' Reply: Relevance of Level IIb Neck Dissection in Patients with Head and Neck Squamous Cell Carcinomas.
World J Surg, 44(5):1693, 01 May 2020
Cited by: 0 articles | PMID: 32123979
Author's Reply: Significance of Intramural Metastasis in Patients with Esophageal Squamous Cell Carcinoma: An Indicator of Aggressive Cancer Behavior.
World J Surg, 43(10):2649-2650, 01 Oct 2019
Cited by: 0 articles | PMID: 31359077
Go to all (6) article citations
Similar Articles
To arrive at the top five similar articles we use a word-weighted algorithm to compare words from the Title and Abstract of each citation.
Relevance of level IIb neck dissection in patients with papillary thyroid carcinoma.
J Laryngol Otol, 135(3):269-272, 23 Feb 2021
Cited by: 1 article | PMID: 33618782
Level IIb lymph node metastasis in laryngeal squamous cell carcinoma.
Laryngoscope, 116(2):268-272, 01 Feb 2006
Cited by: 25 articles | PMID: 16467717
Nodal metastases at level IIb during neck dissection for head and neck cancer: clinical and pathologic evaluation.
Head Neck, 30(11):1483-1487, 01 Nov 2008
Cited by: 17 articles | PMID: 18798305
Level IIB lymph node metastasis in laryngeal and hypopharyngeal squamous cell carcinoma: single-institution case series and review of the literature.
Laryngoscope, 123(12):3032-3036, 06 Aug 2013
Cited by: 8 articles | PMID: 23686866
Review
Prophylactic dissection of level V in primary mucosal SCC in the clinically N positive neck: A systematic review.
Laryngoscope, 127(9):2074-2080, 14 Apr 2017
Cited by: 6 articles | PMID: 28411387
Review