title: When to manage level V in head and neck carcinoma?
abstract: OBJECTIVE
  As superselective neck dissection strategy is gaining popularity to minimize postoperative morbidity and better life quality, we investigated the metastatic nodal status of level V neck lymph node group for head and neck squamous cell carcinoma in various primary sites. We have also aimed to display the impact of involvement of other nodal groups on level V.
  
  
  METHODS
  Retrospective review of histopathologic examination of case series at a comprehensive cancer center.
  
  
  METHODS
  The study group was composed of 107 patients who underwent a type of neck dissection including level V among 243 patients. The impact of primary site and metastatic nodal status of other levels on metastasis to level V involvement were evaluated.
  
  
  RESULTS
  The most common primary tumor site was oropharynx (n = 43), followed by oral cavity (n = 32), larynx (n = 16), carcinoma of unknown primary (n = 10), and hypopharynx (n = 6). General pathologic N positivity for all levels was 78.3% (76 of 97) when 10 carcinoma of unknown primary patients were excluded. Level V was involved in 13 of 107 (12.1%) patients. Level V was not involved in any patient when the other levels were not involved (0 of 21). Even when considering only N+ patients, the ratio of N positivity for level V is still <20% (13 of 86, 15.1%).
  
  
  CONCLUSIONS
  Because level V was not involved in any patient when the other levels were not involved, it might be reasonable to preserve level V especially in clinically and intraoperatively N0 patients.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey. drbnaib@yahoo.com
authors.forename: Bariş
authors.initials: B
authors.lastname: Naiboğlu
authors.forename: Uğur
authors.initials: U
authors.lastname: Karapinar
authors.forename: Amit
authors.initials: A
authors.lastname: Agrawal
authors.forename: David E
authors.initials: DE
authors.lastname: Schuller
authors.forename: Enver
authors.initials: E
authors.lastname: Ozer
mesh_terms: D000055:Accessory Nerve / Q000601:surgery; D001158:Arteries / Q000601:surgery; D002968:Clavicle / Q000601:surgery; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000473:pathology / Q000601:surgery; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology*; D009062:Mouth Neoplasms / Q000473:pathology / Q000601:surgery; D009333:Neck / Q000098:blood supply; D037981:Neck Dissection / Q000379:methods*; D009334:Neck Muscles / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D009382:Neoplasms, Unknown Primary / Q000473:pathology / Q000601:surgery; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000601:surgery; D010039:Otorhinolaryngologic Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D012189:Retrospective Studies