title: Is dissection of levels 4 and 5 justified for cN0 laryngeal and hypopharyngeal cancer?
abstract: CONCLUSIONS
  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 cN0 necks. 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.
  
  
  METHODS
  A total of 328 cN0 necks operated with selective dissection were reviewed retrospectively. Patients were monitored for at least 24 months and regional recurrences were evaluated.
  
  
  RESULTS
  The prevalence of level 4 occult 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.
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Atatürk Research and Training Hospital, Ministry of Health, Izmir, Turkey.
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Katilmiş
authors.forename: Sedat
authors.initials: S
authors.lastname: Oztürkcan
authors.forename: Ismail
authors.initials: I
authors.lastname: Ozdemir
authors.forename: Bilge
authors.initials: B
authors.lastname: Tuna
authors.forename: Isil Adadan
authors.initials: IA
authors.lastname: Güvenç
authors.forename: Yilmaz
authors.initials: Y
authors.lastname: Ozkul
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000556:secondary / Q000601:surgery*; D007822:Laryngeal Neoplasms / Q000556:secondary / Q000601:surgery*; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods*; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016896:Treatment Outcome