Objectives: In this study we aimed to assess the frequency of distribution for cervical metastases, according to the neck level in patients with larynx cancer who underwent neck dissection. In addition, we also evaluated the safety of selective neck dissection compared to comprehensive neck dissection especially in preoperative N0 patients.
Materials and methods: In our experience, to determine the frequency of metastases in each level, the specimen is sent for pathological examination by dividing each level separately after neck dissection. In our study; we retrospectively analysed the medical records of 145 laryngeal cancer patients who were treated with surgery (total or partial laryngectomy) as primary treatment and combined with neck dissection between 2005 and 2010 in our Otolaryngology Department. The patients with the diagnosis of laryngeal cancer who underwent surgery without neck dissection were excluded from the analysis.
Results: Level I or level V involvement was not observed in preoperative N0 cases. In cases that had contralateral involvement, there was ipsilateral involvement too and all of these cases were preoperative N+ cases. The classification based on the distribution of levels of 145 cases’ cervical metastases revealed that among ipsilateral involvements, 1 (0.6%) was detected at level IA, 32 (22%) at level IIA, 3 (2%) at level IIB, 19 (13%) at level III, 2 (1.3%) at level IV and 1 (1.3%) at level V. When contralateral involvement considered, 13 (8.9%) were detected at level IIA and 1 (0.6%) at level III.
Conclusions: The neck specimen findings of 145 laryngeal cancer patients treated with surgery as either total or partial laryngectomy and combined with neck dissection revealed that the most common metastases were observed at the level IIA and level III; however metastases at level I, level IIB, level IV and level V were least common. Those findings indicated that selective neck dissection was a safe surgical approach (levels II-IV) in T1 T2 N0 cases.