Nodal level affection in elective neck dissection for squamous cell carcinoma of the larynx

The best prophylactic treatment for the NO neck is a subject of debate. Some authors propose lateral selective lymph node dissection [levels II-IV] for laryngeal squamous cell carcinoma [SCC] on the basis of probability of finding occult metastases in those lymph nodes. The necessity of routine dissection at level IV has been questioned. The purpose of this study was to find the incidence of level IV metastases in patients with transglottic and supraglottic SCC who underwent lateral neck dissection. We retrospectively evaluated 54 patients with N0 supraglottic and transglottic SCC who underwent total laryngectomy and selective [level II-IV] neck dissection. Twelve patients [22.2%] had occult neck metastases, 3 of them had also contralateral occult positive nodes. Level IV involvement occurred only in one patient [1.85%] ipsilaterally who had also other positive ipsilateral nodes at level II-III. Extracapsular spread [ECS] occurred in 23.8% of positive nodes. Elective dissection of level IV in clinically NO supraglottic and transglottic SCC may be unnecessary and reserved for cases with highly suspicious involvement of level II-III nodes to avoid occasional morbidity associated with its dissection