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Turk Arch Otorhinolaryngol. 2018 Sep;56(3):139-144. doi: 10.5152/tao.2018.3420. Epub 2018 Sep 1.

Distribution of Metastatic Nodes in N0-1 Patients with Tonsillar Squamous Cell Carcinoma and Its Implications for Selective Neck Dissection.

Author information

1
Department of Head and Neck Surgery and Otorhinolaryngology, A. C. Camargo Cancer Center, São Paulo, Brazil.
2
Department of Pathology, A. C. Camargo Cancer Center, São Paulo, Brazil.
3
Department of Research and Development, A. C. Camargo Cancer Center, São Paulo, Brazil.

Abstract

Objective:

We aimed to evaluate the pattern of neck metastasis in patients with primary tonsillar carcinoma treated by primary surgery and neck dissection. Impact of the extent of neck dissection and level of metastatic nodes on survival were also evaluated.

Methods:

We evaluated 163 consecutive patients with tonsillar squamous cell carcinoma submitted for neck dissection and staged as cN0-1. Selective neck dissection was performed using a template encompassing levels I-III, whereas radical neck dissection led to the removal at levels I-V. For each patient, number of metastatic nodes, their distribution, and data regarding postoperative treatment and oncologic outcomes were analyzed.

Results:

Occult neck metastasis at levels I, IV, and V were rare with two cases each. In the clinically negative (cN0) patients, there were no cases of metastasis at level V and two cases at level I or IV. The extent of neck dissection and level of metastatic nodes had no impact on disease-specific survival or neck recurrence.

Conclusion:

We conclude that in cN0 patients, removal at levels II and III is mandatory but levels I, IV, and V may be spared.

KEYWORDS:

Oropharyngeal neoplasms; metastasis; neck dissection; palatine tonsil; squamous cell carcinoma

Conflict of interest statement

Conflict of Interest: The authors have no conflicts of interest to declare.

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