Is dissection of levels 4 and 5 justified for cN0 laryngeal and hypopharyngeal cancer?

Conclusion. Dissecting levels 2 and 3 and sparing the dissection of level 4 and the contralateral neck when frozen section results are negative are reasonable options for the selective dissection of cN0necks. Our findings show that dissection of level 5 is considered unnecessary, unless there is overt metastasis. Objective. The level of node involvement and recurrence rates were assessed in cN0 laryngeal and hypopharyngeal carcinoma patients in order to develop appropriate guidelines for the treatment of the neck. Materials and methods. A total of 328 cN0necks operated with selective dissection were reviewed retrospectively. Patients were monitored for at least 24months and regional recurrences were evaluated. Results. The prevalence of level 4occult metastases was 3.4%; 1.5% of them were isolated to level 4. We observed regional recurrence in 5.6% of the necks. No case of metastasis or regional relapse was observed in level 5.

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