Lymph Node Yield in Therapeutic Neck Dissection: Impact of Dissection Levels and Prior Radiotherapy

Objective: Lymph node yield in therapeutic neck dissection is clinically significant and incompletely studied. We quantified node yield based on extent of neck dissection and presence of preoperative radiation. We also evaluated factors affecting incidence of extracapsular spread (ECS). Methods: Retrospective review of 499 patients undergoing therapeutic neck dissection; 414 patients met inclusion criteria and were divided into 2 groups: neck dissection alone or before radiation (surgery first: 280 patients; 385 dissections) and primary radiation before surgery (radiation first: 134 patients; 157 dissections). Node yield relative to levels dissected and incidence of ECS were examined. Results: Dissection-specific node yield was greater in the surgery first group for dissection of levels I-V (31.1 ± 16.7 vs 24.0 ± 14.7, P < .001) and levels II-V (26.7 ± 14.4 vs 21.1 ± 10.7). Extracapsular spread incidence was 32.1% (98/305) in the surgery first group and 15.4% (23/149) in the radiation first group ( P < .001). Conclusion: This study clarifies anticipated node yield based on number of levels dissected and presence of preoperative radiation. Node yield and incidence of ECS are lower in patients undergoing preoperative radiation.

Download Full-text

Factors affecting the adequacy of lymph node yield in prophylactic unilateral central neck dissection for papillary thyroid carcinoma

Journal of Surgical Oncology ◽

10.1002/jso.23201 ◽

2012 ◽

Vol 106 (8) ◽

pp. 966-971 ◽

Cited By ~ 16

Author(s):

Brian Hung-Hin Lang ◽

Patricia Chun-Ling Yih ◽

Tony W.-H. Shek ◽

Koon Yat Wan ◽

Kai Pun Wong ◽

...

Keyword(s):

Lymph Node ◽

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Neck Dissection ◽

Central Neck Dissection ◽

Central Neck ◽

Papillary Thyroid ◽

Lymph Node Yield ◽

Factors Affecting ◽

Node Yield

Download Full-text

Lymph node yield in treatment naïve cases of head and neck squamous cell carcinoma: en bloc lymphadenectomy versus level-by-level dissection

The Journal of Laryngology & Otology ◽

10.1017/s0022215121000621 ◽

2021 ◽

pp. 1-8

Author(s):

K Devaraja ◽

K Pujary ◽

B Ramaswamy ◽

D R Nayak ◽

N Kumar ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Lymph Node ◽

Cell Carcinoma ◽

Head And Neck ◽

Neck Dissection ◽

Squamous Cell ◽

Neck Squamous Cell Carcinoma ◽

En Bloc ◽

Lymph Node Yield ◽

Node Yield

Abstract Background Lymph node yield is an important prognostic factor in head and neck squamous cell carcinoma. Variability in neck dissection sampling techniques has not been studied as a determinant of lymph node yield. Methods This retrospective study used lymph node yield and average nodes per level to compare level-by-level and en bloc neck dissection sampling methods, in primary head and neck squamous cell carcinoma cases operated between March 2017 and February 2020. Results From 123 patients, 182 neck dissections were analysed, of which 133 were selective and the rest were comprehensive: 55 had level-by-level sampling and 127 had undergone en bloc dissection. The level-by-level method yielded more nodes in all neck dissections combined (20 vs 17; p = 0.097), but the difference was significant only for the subcohort of selective neck dissection (18.5 vs 15; p = 0.011). However, the gain in average nodes per level achieved by level-by-level sampling was significant in both groups (4.2 vs 3.33 and 4.4 vs 3, respectively; both p < 0.001). Conclusion Sampling of cervical lymph nodes level-by-level yields more nodes than the en bloc technique. Further studies could verify whether neck dissection sampling technique has any impact on survival rates.

Download Full-text

Impact of Lymph Node Yield in Patients Undergoing Total Laryngectomy and Neck Dissection

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420964824 ◽

2020 ◽

pp. 000348942096482

Author(s):

Michael C. Topf ◽

Ramez Philips ◽

Joseph Curry ◽

Linda C. Magana ◽

Madalina Tuluc ◽

...

Keyword(s):

Radiation Therapy ◽

Lymph Node ◽

Neck Dissection ◽

Total Laryngectomy ◽

Single Institution ◽

Level Of Evidence ◽

Lymph Node Yield ◽

Positive Margins ◽

The Impact ◽

Node Yield

Objectives: To determine the impact of lymph node yield (LNY) in patients undergoing neck dissection at the time of total laryngectomy (TL). To determine the impact of radiation therapy (RT) on LNY. Methods: Retrospective review of LNY and clinical outcomes in 232 patients undergoing primary or salvage total laryngectomy (TL) with ND. Results: Preoperative RT significantly decreased mean LNY from 31.7 to 23.9 nodes ( P < .001). In primary TL patients, age ( P < .001) and positive margins ( P = .044) were associated with decreased OS. In salvage TL patients, only positive margins was associated with poorer OS ( P = .009). No LNY cutoff provided significant OS or DFS benefit. Conclusions: Radiotherapy significantly reduces LNY in patients undergoing TL and ND. Within a single institution cohort, positive margins, but not LNY, is associated with survival in both primary and salvage TL patients. Level of Evidence: 4

Download Full-text

Impact of Lymph Node Yield on Survival in Surgically Treated Oropharyngeal Squamous Cell Carcinoma

Otolaryngology ◽

10.1177/0194599820936637 ◽

2020 ◽

pp. 019459982093663

Author(s):

Ernest D. Gomez ◽

Joyce C. Chang ◽

John J. Ceremsak ◽

Robert M. Brody ◽

Jason A. Brant ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Lymph Node ◽

Cell Carcinoma ◽

Neck Dissection ◽

Squamous Cell ◽

Hazard Ratio ◽

National Cancer Database ◽

Adjuvant Chemoradiation ◽

Lymph Node Yield ◽

Node Yield

Objectives (1) To estimate the association between neck dissection lymph node yield (LNY) and survival among patients with surgically treated human papilloma virus (HPV)–associated oropharyngeal squamous cell carcinoma (OPSCC). (2) To identify a clinically relevant quality metric for surgical treatment of HPV-related OPSCC. Study Design Retrospective cohort study. Setting National Cancer Database. Subjects and Methods From the National Cancer Database, 4130 patients were identified with HPV-associated OPSCC treated with primary surgery from 2010 to 2016. Based on prior literature, an adequate neck dissection LNY was defined as ≥18 lymph nodes. To determine whether LNY is associated with survival, univariable and multivariable Cox proportional hazards regression was performed. Analysis was stratified by adjuvant therapy regimen. Results A total of 2113 patients (51.2%) underwent surgery with or without adjuvant radiation (S ± RT), and 2017 patients (48.8%) underwent surgery with adjuvant chemoradiation. LNY ≥18 was associated with a 5-year survival benefit of 7.15% (91.7% for LNY ≥18, 84.5% for LNY <18, P = .004) for the S ± RT cohort on unadjusted survival analysis. For the S ± RT group, LNY ≥18 was associated with decreased hazard of death (hazard ratio, 0.45; 95% CI, 0.29-0.70; P < .001) after adjustment for patient characteristics, TNM staging, surgical margins, extranodal extension, and treating facility characteristics. For surgery with adjuvant chemoradiation, the adjusted hazard ratio estimate for LNY ≥18 was 0.64 (95% CI, 0.41-1.00), but the result was not statistically significant ( P = .052). Conclusion An adequate LNY from a neck dissection may affect survival when HPV-related OPSCC is treated with up-front surgery.

Download Full-text