[Neck dissection of Levels II and III for the treatment of supraglottic laryngeal cancer with clinically negative neck].

OBJECTIVE

To evaluate the feasibility of routine inclusion of levels II and III in neck dissection to treat the occult neck metastasis as elective treatment for supraglottic cancer with clinically node negative (cN0).

METHODS

The results of 52 cN0 patients with supraglottic cancer treated in Tumor Hospital, Harbin Medical University from October 2002 to March 2006 were reviewed retrospectively.

RESULTS

Of the 52 patients with supraglottic cancer and cN0 neck, 32 cases received ipsilateral SND (levels II and III) and 20 cases with bilateral SND (levels II and III). Fifteen (28.9%) of 52 patients were found to have occult regional metastasis on pathological examination. Three patients without metastasis in dissected side at pathologic examination showed metastasis in the contralateral undissected neck later on therefore the total occult metastasis rate was 34.6% (18 of 52). The unilateral and bilateral neck occult metastases were determined in 15 cases (28.9%) and 3 cases (5.8%) respectively. A total of 1190 lymph nodes were harvested in 72 specimens, with 30 positive nodes. The distributions of the 30 positive nodes were as follows: level IIA 83.3% (25 nodes), level III 16.7% (5 nodes). Three-year regional recurrence rate was 5.8%. The 3-year survival rate was 84.6% according to Kaplan-Meier in all cN0 patients (n = 52). Patients with positive neck metastasis and patients with extracapsular spread had higher regional recurrence rates (P = 0.021 and 0.002, respectively).

CONCLUSIONS

The results support the use of SND (levels II and III) in cN0 supraglottic cancer. This procedure will reduce both operating time and morbidity, without compromising the oncologic result.