Management of cervical lymph node metastasis in tonsillar squamous cell carcinoma: Is it necessary to treat node-negative contralateral neck?
OBJECTIVE
To investigate the appropriate management of cervical lymph node metastasis in patients with tonsillar squamous cell carcinoma (SCC).


METHODS
The medical records of 49 patients that were surgically treated for tonsillar SCC were evaluated. Preoperative and postoperative stages, clinical factors affecting the nodal metastasis, and its relationship with survival were examined.


RESULTS
Among 49 ipsilateral neck dissection (ND) specimens, 34 neck specimens (69%) were pN+. Out of 17 cases that underwent ipsilateral elective NDs, 4 cases (24%) were found to have pN+ necks. The disease-specific survival of the 34 patients with pN+ necks and 4 patients with occult metastases was worse than that of the remaining patients with pN0 necks and without occult metastasis, respectively (p=0.049 and p=0.023, respectively). All cases (100%) that underwent contralateral therapeutic NDs had pN+ findings. Two out of the 21 cases (less than 10%) that underwent contralateral elective NDs turned out to have pN+ necks and did not show any difference in survival compared to the 19 cases with pN0 necks. The degree of differentiation was associated with contralateral nodal metastasis.


CONCLUSIONS
Patients with tonsillar SCC require thorough ipsilateral neck treatment because of the high probability of nodal metastasis and the close association between lymph node metastasis and survival. The contralateral cN+ neck should also be treated; however, the contralateral cN0 neck might be preserved with caution on the cases with poorly differentiated primary tumors and/or ipsilateral cN+ necks.
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Kwang Jae
KJ
Cho
Young Hoon
YH
Joo
Dong Il
DI
Sun
Min Sik
MS
Kim
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000601:surgery*; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009333:Neck; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D015996:Survival Rate; D014067:Tonsillar Neoplasms / Q000601:surgery*; D019564:Unnecessary Procedures