Necessity of level IV dissection in cN0 hypopharyngeal carcinoma

Conclusions: We suggest that contralateral level IV dissection is not necessary in patients with cN0 hypopharyngeal squamous cell carcinoma (HPSCC). Objectives: Elective treatment of neck nodes is very important in the management of cN0 HPSCC. A selective neck dissection neck level II to IV (SND II-IV) is widely accepted as an elective neck treatment of cN0 HPSCC. However, there has been a lot of effort to reduce the extent of surgery. Therefore, we investigated the incidence of level IV metastasis and regional recurrence in cN0 HPSCC. Methods: We performed a retrospective review of 40 patients who underwent SND II-IV as an elective treatment for cN0 HPSCC from 1992 to 2010. Results: In all, 30 bilateral and 10 unilateral SND II-IVs were performed in 40 patients. Of the 70 SND II-IV specimens, 15 specimens from 14 patients (21%) were revealed to have positive lymph node metastasis. Level IV was involved in 3 of 70 necks (4.2%), but no isolated or contralateral level IV metastasis was observed. Every case that had level IV metastasis also had positive nodes in level II or III. There was no case of postoperative chylous leakage and only one case of phrenic nerve palsy.