Assessing the need for doing a Level V cervical lymph node dissection for all clinically positive cervical lymph nodes in squamous cell cancers of the oral cavity and predicting factors indicating metastatic involvement of Level V lymph nodes

Volume : VII, Issue : V, May - 2018

Dr. Siddhartha Biswas, Professor Dr. Rupnarayan Bhattacharya, Dr. Kausik Das, Dr. Goutam Guha, Dr. Sourav Chowdhury, Dr. Dipmalya Chatterjee

Posterior triangle lymph node dissection(Level V lymph node dissection ) of neck is a part & parcel of Modified Radical neck

dissection(MRND) and carries with it the risk of shoulder dysfunction due to spinal accessory nerve traction or iatrogenic injury

during dissection. The aim of our study was to determine the role of dissection of Level V lymph nodes in patients suffering from

Oral squamous cell cancers & to determine the factors that predicted level V lymph node metastasis .We had studied 108 patients

with Oral SCC on whom we had performed a MRND and had dissected and separately labelled Level V lymph node and sent them

separately for histopathological examination to detect their involvement . Amongst 108 patients , 33 were clinically N0 (cN0). And

none had Level V lymph node metastasis.Of the 75 patients with positive neck nodes, 30 patients were clinically N1and of these

21 patients had only Level 1B & the rest 9 had level 2/3 lymph node involvement.None of these patients had Level V lymph nodal

involvement . Out of the 75 clinically node positive patients , 45 patients were clinically N2 ( cN2). Only 6 patients among these 45

patients; who were both clinically and pathologically N2, had Level V lymph nodal metastasis. Overall Level V lymph node

involvement was only in 5.5 %(6 patients) according to our study. Of this tongue cancers(4 patients ) were the most common

cancers to have Level V lymph nodal metastasis.All patients who had Level V lymph nodal metastasis also had Extracapsular

spread(100%).Due to the very low incidence of level v lymph nodal metastasis that we found in our study we concluded that one

could safely undergo selective neck dissection ( SND)in cN0 patients & cN1 patients with only Level 1 B involvement selectively .

Potential risk factors for Level V lymph nodal metastasis were clinically evident ECS, and large fixed multiple cervical lymph nodal

involvement