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Lymph node yield in treatment naïve cases of head and neck squamous cell carcinoma: en bloc lymphadenectomy versus level-by-level dissection

Published online by Cambridge University Press:  15 March 2021

K Devaraja ,
K Pujary ,
B Ramaswamy ,
D R Nayak ,
N Kumar  and
D Nayak
K Devaraja*
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College and Hospital, Manipal, Manipal Academy of Higher Education, Udupi, India
K Pujary
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College and Hospital, Manipal, Manipal Academy of Higher Education, Udupi, India
B Ramaswamy
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College and Hospital, Manipal, Manipal Academy of Higher Education, Udupi, India
D R Nayak
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College and Hospital, Manipal, Manipal Academy of Higher Education, Udupi, India
N Kumar
Affiliation:
Department of Surgical Oncology, Manipal Comprehensive Cancer Care Center, Kasturba Hospital, Manipal Academy of Higher Education, Udupi, India
D Nayak
Affiliation:
Department of Pathology, Kasturba Medical College and Hospital, Manipal, Manipal Academy of Higher Education, Udupi, India
*
Author for correspondence: Dr K Devaraja, Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College and Hospital, Manipal, Manipal Academy of Higher Education, Udupi, Karnataka, India – 576104 E-mail: deardrdr@gmail.com
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Abstract

Background

Lymph node yield is an important prognostic factor in head and neck squamous cell carcinoma. Variability in neck dissection sampling techniques has not been studied as a determinant of lymph node yield.

Methods

This retrospective study used lymph node yield and average nodes per level to compare level-by-level and en bloc neck dissection sampling methods, in primary head and neck squamous cell carcinoma cases operated between March 2017 and February 2020.

Results

From 123 patients, 182 neck dissections were analysed, of which 133 were selective and the rest were comprehensive: 55 had level-by-level sampling and 127 had undergone en bloc dissection. The level-by-level method yielded more nodes in all neck dissections combined (20 vs 17; p = 0.097), but the difference was significant only for the subcohort of selective neck dissection (18.5 vs 15; p = 0.011). However, the gain in average nodes per level achieved by level-by-level sampling was significant in both groups (4.2 vs 3.33 and 4.4 vs 3, respectively; both p < 0.001).

Conclusion

Sampling of cervical lymph nodes level-by-level yields more nodes than the en bloc technique. Further studies could verify whether neck dissection sampling technique has any impact on survival rates.

Keywords

Head And Neck CancerSquamous Cell CancerNeck DissectionLymph NodesOral CancerLarynx
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 135 , Issue 4 , April 2021 , pp. 359 - 366
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Dr K Devaraja takes responsibility for the integrity of the content of the paper

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