Selective modified radical neck dissection for XXXX -is level I, II and V dissection always necessary?

@entity1 @entity3 @entity66 @entity3557
BACKGROUND: There is ongoing controversy as to the indications for and extent of lateral cervical lymphadenectomy for @entity1 with @entity3557 ( @entity3557 ). While most now agree that prophylactic lymph node dissections (LND) play no role, at the University of California, San Francisco (UCSF) we limit LND selectively on a level by level basis, and resect only the levels thought to @entity66 or to be at increased risk of @entity3 . This initial 'selective LND' usually includes levels III and IV (due to the well-documented increased likelihood of @entity3 to these levels) and levels I, II, and V are included when there is clinical or radiological evidence of disease or increased risk of it. METHODS: A retrospective review of the clinical charts and hospital records of 106 consecutive @entity1 who had metastatic @entity3557 and who underwent at least one lateral cervical LND at UCSF between January 1995 and December 2003 was carried out. Data were collected to assess which @entity1 had levels I, II, and/or V included in their initial ipsilateral and/or contralateral LND and to determine the recurrence rates at these levels if they had previously been excised compared with if they had not. Chi-squared and Fisher exact tests were utilized for statistical comparison, where appropriate. RESULTS: A total of 140 initial lateral LND were performed: 104 ipsilateral and 36 contralateral. In these initial LND, 3.9%, 72.5%, and 18.6% of @entity1 had levels I, II, and V resected on the ipsilateral side, and 2.9%, 60.0%, and 37.1% of @entity1 had levels I, II, and V resected on the contralateral side. Recurrence at levels I and V was uncommon in all @entity1 populations. Recurrence at level II was 19% ipsilaterally and 10% contralaterally when the level was previously resected and 21% ipsilaterally and 14% contralaterally when the level was not previously resected. There was no statistically significant difference in recurrence at level II when the level had previously been resected compared with when it had not. CONCLUSIONS: If utilized in the appropriate @entity1 population, a selective approach to lateral cervical LND for @entity3557 can be a successful alternative to the routine modified radical LND. Levels I and V do not require resection unless there is clinical or radiological evidence of disease. Guidelines for which @entity1 may be considered for this less aggressive approach to level II nodal @entity3 are suggested.
