Relevance of level I neck dissection in oropharyngeal carcinoma

Česká verze

Authors: F. Campsie ; Z. Horáková ; Richard Salzman
Authors place of work: Klinika otorinolaryngologie a chirurgie hlavy a krku LF UP a FN Olomouc
Published in the journal: Otorinolaryngol Foniatr, 75, 2026, No. Ahead of Print, pp. 1-6.
Category: Původní práce
doi: https://doi.org/10.48095/ccorl2026-003

Summary

Introduction: Comprehensive neck dissection involving level I is the standard of care for patients undergoing primary surgical treatment for clinically apparent cervical lymph node involvement. However, the current trend is to reduce the radicality of neck dissection in terms of the selection of dissected areas without compromising oncological radicality. Objective: To evaluate the risk of metastasis in level I based on the incidence of occult metastases in patients with oropharyngeal carcinoma presenting with clinical lymph node involvement outside this region. These findings could contribute to refining the extent of neck dissections, specifically regarding the omission of level I from therapeutic neck dissections. Methodology and materials: This retrospective study analyzes the occurrence of occult lymph node metastases in level I. Out of a total of 229 patients with oropharyngeal carcinoma treated between 2018 and 2022 at the Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Olomouc, 59 patients with metastatic lymph node involvement in levels II–V were selected. All of these patients underwent primary surgical treatment, which included comprehensive therapeutic neck dissection. Results: Occult metastasis was identified in level I lymph nodes in only 1 patient (1.6%), specifically in level IB. During the follow-up period (median of 30 months), regional lymph node recurrence in level I was observed in only 1 patient as part of multiple lymph node relapses. According to the Kaplan-Meier survival analysis, the estimated 3-year survival rate is 90%, with a 3-year recurrence-free interval probability of 76%. Conclusion: This study supports omitting dissection of level I from comprehensive block neck dissection, thereby preserving the submandibular gland and performing a wider exenteration of lymph nodes around level IIA.

Keywords:

surgery – Oropharynx – neck dissection – oropharyngeal squamous cell carcinoma – lymphatic metastasis

Zdroje

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