Is Routine Bilateral Neck Dissection Absolutely Necessary in the Management of N0 CT Negative Neck in Patients with T4 Laryngeal Head and Neck Carcinoma?

Didier Dequanter, Delphine Geukens, Jean-Marie Bailly, Mohammad Shahla, Pascal Paulus, Philippe Lothaire

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DOI: 10.4236/jct.2011.23044                

Abstract

Objectives: Elective neck treatment of clinically N0 patients in patients with head and neck carcinomas is widely accepted as a standard approach. However, the issue whether elective neck treatment should routinely be directed on both sides of the neck is still controversial. The present study is aimed at determining whether T4 staged head and neck carcinomas required bilateral neck dissection in the management clinically No necks especially CT negative cervical nodes. Methods: We performed a retrospective analysis of patients with advanced head and neck disease who received bilateral neck dissection. All the patients had curative surgery as their initial treatment for the primary tumor and the neck. Results: All the 28 consecutive patients had T4 staged primary laryngeal cancer. Patients with clinically and radiologically N+ disease had invaded lymph node metastases in all cases. Patients staged clinically and radiologically N0 had no invaded cervical lymph nodes found by pathologic examination. Patients staged clinically N0 and radiologically N+ had invaded cervical lymph nodes in 8/12 cases and in 50% (4/8) of the cases bilaterally. Conclusion: This study showed the importance on adequate clinical and radiological staging. By patients with advanced disease clinically and radiologically N0, bilateral neck dissection should not be necessary. But in patients radiologically N+, routine bilateral neck dissection is beneficial.

Keywords

Advanced Head And Neck Cancer, Bilateral Neck Dissection, Radiological Evaluation

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	S. Cagli, I. Yce, O. G. Yigitbasi and E. Guney, “Is Routine Bilateral Neck Dissection Absolutely Necessary in the Management of N0 Neck in Patients with Supraglottic Carcinoma,” European Archives of Oto-Rhino-Laryngology, Vol. 264, No. 12, 2007, pp. 1453-1457. doi:10.1007/s00405-007-0384-z
[2]	Y. C. Lim, E. C. Choi, J. S. Lee, B. S. Koo, M. H. Song and H. A. Shin, “Is Dissection of Level IV Absolutely Necessary in Elective Lateral Neck Dissection for Clinically N0 Laryngeal Carcinoma,” Oral Oncology, Vol. 42, No. 1, 2006, pp. 102-107. doi:10.1016/j.oraloncology.2005.06.019
[3]	G. Y. Tu, “Upper Neck (Level II) Dissection for N0 Neck Supraglottic Carcinoma,” Laryngoscope, Vol. 109, 1999, pp. 467-470.
[4]	A. Ferlito, C. E. Silver and A. Rinaldo, “Selective Neck Dissection: A Rational Replacement for Complete Functional Neck Dissection in Patients with N0 Supraglottic and Glottic Carcinoma,” Head and Neck, Vol. 118, 2008, pp. 676-679.
[5]	O. Gallo, I. Fini-Storchi and L. Napolitano, “Treatment of the Controlateral Negative Neck in Supraglottic Cancer Patients with Unilateral Node Metastases (N1-N3),” Head and Neck, Vol. 22, No. 4, 2000, pp. 386-392. doi:10.1002/1097-0347(200007)22:4<386::AID-HED12>3.0.CO;2-5
[6]	J. Kligerman, L. O. Olivatto, R. A. Lima, E. Q. Freitas, J. R. Soares, F. L. Dias, L. E. Melo, G. M. Sa and E. Deuccini, “Elective Neck Dissection in the Treatment of T3/T4 N0 Squamous Cell Carcinoma of the Larynx,” The American Journal of Surgery, Vol. 170, No. 5, 1995, pp. 436-439. doi:10.1016/S0002-9610(99)80324-9
[7]	T. E. Alpert, S. Morbidini-Gaffney, C. T. Chung, J. A. Bogart, S. S. Hahn, J. Hsu and R. M. Kellmean, “Radiotherapy for the Clinically Negative Neck in Supraglottic Laryngeal Cancer,” Cancer Journal, Vol. 10, 2004, pp. 335-338.
[8]	B. S. Koo, Y. C. Lim, J. S. Lee and E. C. Choi, “Management of Controlateral N0 Neck in Oral Cavity Squamous Cell Carcinoma,” Head and Neck, Vol. 28, No. 10, 2006, pp. 896-901. doi:10.1002/hed.20423
[9]	B. S. Koo, Y. C. Lim, J. S. Lee, Y. H. Kim, S. H. Kim and E. C. Choi, “Management of Controlateral N0 neck In Pyriform Sinus Carcinoma,” Laryngoscope, Vol. 116, No. 7, 2006, pp. 1268-1272. doi:10.1097/01.mlg.0000225936.88411.71
[10]	Y. C. Lim, S. Y. Lee, J. Y. Lim, J. S. Lee, B. S. Koo, S. H. Kim and E. C. Choi, “Management of Controlateral N0 Neck in Tonsillar Squamous Cell Carcinoma,” Laryngoscope, Vol. 115, No. 9, 2005, pp. 1672-1675. doi:10.1097/01.mlg.0000184791.68804.0b
[11]	Y. C. Lim, B. S. Koo, J. S. Lee, J. Y. Lim and E. C. Choi, “Distribution of Cervical Lymph Node Metastases in Oropharyngeal Carcinoma: Therapeutic Implications for the N0 Neck,” Laryngoscope, Vol. 116, No. 7, 2006, pp. 1148-1152. doi:10.1097/01.mlg.0000217543.40027.1d
[12]	L. O. Redaelli de Zinis, P. Nicolai, D. Tomenzoli, D. Ghizzardi, M. Trimarchi, J. Cappiello, G. Peretti and A. R. Antonelli, “The Distribution of Lymph Nodes Metastases in Supraglottic Squamous Cell Carcinoma: Therapeutic Implications,” Head and Neck, Vol. 24, No. 10, 2002, pp. 913-920. doi.org/10.1002/hed.10152