title: Selective neck dissection for N0 and N1 oral cavity and oropharyngeal cancer: are skip metastases a real danger?
abstract: OBJECTIVE
  To contribute to insight in therapeutic safety of selective neck dissections for oral cavity and oropharyngeal cancer with a special focus on the risk of skip metastases.
  
  
  METHODS
  Retrospective data analysis.
  
  
  METHODS
  Tertiary referral centre.
  
  
  METHODS
  A total of 291 patients operated for oral cavity or oropharyngeal squamous cell cancer between 1999 and 2004.
  
  
  METHODS
  Incidence of skip metastases in both pathologically N0 and N+ necks for oral cavity and oropharyngeal cancer.
  
  
  RESULTS
  Of all neck dissections (n = 226) performed for oral cavity cancer, skip metastases to level III or level IV occurred in 14 cases (6%). Ten skip metastases occurred in level III only (10/226 = 4%). Thus, four necks had metastases in level IV, which would not have been removed in case of a Selective neck dissection level I-III (supraomohyoid neck dissection). In case of oropharyngeal cancer, skip metastases to level III or level IV occurred in six of 92 cases (7%). Five skip metastases occurred in level III only (5/92 = 5%). This means that of the necks containing skip metastases, only one neck (1%): had metastases in level IV, which would not have been removed in case of a Selective neck dissection level I-III (Supraomohyoid neck dissection).
  
  
  CONCLUSIONS
  The question whether level IV should be included in the treatment of N0 and even N1 necks of patients with cancer of the oral cavity and oropharynx cannot be answered by all data available to us now. The fear of skip metastases including level IV does not seem to be justified.
authors.affiliation: Department of Otorhinolaryngology, Erasmus Medical Centre, Rotterdam, The Netherlands. wouter_lodder@hotmail.com
authors.forename: W L
authors.initials: WL
authors.lastname: Lodder
authors.forename: A
authors.initials: A
authors.lastname: Sewnaik
authors.forename: M A
authors.initials: MA
authors.lastname: den Bakker
authors.forename: C A
authors.initials: CA
authors.lastname: Meeuwis
authors.forename: J D F
authors.initials: JD
authors.lastname: Kerrebijn
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D009062:Mouth Neoplasms / Q000473:pathology / Q000601:surgery*; D037981:Neck Dissection / Q000379:methods*; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors