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Young-Ho Kim, MD; Bon Seok Koo, MD; Young Chang Lim, MD; Jin Seok Lee, MD; Se-Heon Kim, MD; Eun Chang Choi, MD, PhD

Arch Otolaryngol Head Neck Surg. 2006;132:1060-1064.

Objectives  To evaluate the prevalence of level IIb lymph node (LN) metastasis and to identify potential clinical risk factors when level IIb metastatic diseases are present in patients with clinically node-negative (N0) and node-positive (N+) necks with hypopharyngeal squamous cell carcinoma (HPSCC). This will provide a basis for determining whether this region can be excluded in elective or therapeutic neck dissection in patients with HPSCC.

Design  Prospective analysis of a case series.

Setting  University hospital.

Patients  Fifty patients with HPSCC who underwent surgical treatment for a primary lesion and simultaneous neck dissection from January 1998 to February 2004.

Main Outcome Measures  The incidences and clinical risk factors for level IIb LN metastasis and regional recurrence according to the presence or absence of pathologic LN involvement in level IIb.

Results  A total of 93 neck dissections were analyzed in this study. Of these dissections, 59 (63%) were elective and 34 (37%) were therapeutic. Three percent (2 of 59) of all N0 necks and 32% (11 of 34) of all N+ necks had level IIb LN metastases. Level IIb nodal metastases were significantly more prevalent in N+ necks (P = .007) than in N0 necks and in the presence of other positive LNs (P = .01) than in the absence of other positive LNs. Of the 35 patients with pathologic LNs, the regional recurrence rate was significantly higher in cases with positive level IIb LNs (33% [4 of 12]) than without (4% [1 of 23]; P = .04).

Conclusions  Level IIb LN pads may be preserved during elective neck dissection in the treatment of patients with clinically N0 necks with HPSCC. This area should be removed during therapeutic neck dissection in the treatment of clinically N+ necks.

Author Affiliations: Department of Otorhinolaryngology, Yonsei University College of Medicine (Drs Y.-H. Kim, Koo, Lee, S.-H. Kim, and Choi), and Department of Otorhinolaryngology–Head and Neck Surgery, Konkuk University College of Medicine (Dr Lim), Seoul, South Korea.