Abstract :
Background: Dissection of level llb nodal group in the posterior triangle apex is a standard step during lateral neck dissection in patients with laryngeal cancer with clinically NO neck. Dissection of this level is difficult and may be associated with increased surgical morbidity. In this study, we evaluated the prevalence of level lib metastasis in patients with laryngeal cancer in order to assess the need for performing routine level lib dissection during neck dissection procedures. Methods: Thirty-seven patients with laryngeal squamous cell carcinoma (See) were included in this study. The study was performed in a prospective fashion. All patients had laryngectomy with neck dissection, either unilateral or bilateral. After completion of the neck dissection, level lib was resected and sent separately for histopathological examination. The prevalence of level llb metastasis as well as metastasis in other node groups were assessed. The prevalence of level lib metastasis in relation to the clinical stage of the neck, site and clinical stage of the primary tumor, and the presence of metastasis in other nodes were assessed and analyzed. Results: A total of 49 neck dissections were done. Eleven were therapeutic for the treatment of clinically positive neck and 38 were elective for the treatment of NO neck. The overall prevalence of nodal metastasis was 43.2%. Nodal metastasis in patients with NO neck was 21%, and in the clinically positive neck was 100%. Level lib nodal metastasis occurred in 16.2% of all cases and in 0% and 66.7% in patients with clinically NO and node positive necks, respectively. The incidence of level lib metastasis was 20%, 0% and 23.1% for supraglottic, glottic and transglottic tumors, respectively. All patients with pathological level lib involvement were T3 and T4. Conclusion: Level lib dissection should be routinely performed during elective neck dissection for patients with supraglottic and transglottic See, as well as in advanced stage (T3 and T4) lesions. In patients with glottic cancer, and those with early (T1 T2) lesions dissection of level lib may not be necessary. In patents with clinically positive neck nodes this site should be adequately resected.
