Lymph nodal recurrence in levels IV and V in oral squamous cell carcinoma after neck dissection

Background: The aim of the study was to determine the risk of lymph node recurrence in levels IV and V after tumour resection and neck dissection of level I-III and level I-V.

Methods: Data from 228 patients suffering from OSCC were analysed retrospectively. Patients with level I-III neck dissection were compared to those with level I-V neck dissection in terms of number and location of nodal recurrence. The incidence of level IV-V recurrence in patients who had received level I-III neck dissection was compared with that of patients who had received level I-V neck dissection. The incidence of level IV-V recurrence was also compared between patients with pN0 and pN+ necks.

Results: Overall, 19 patients developed metastases. Only in two cases appeared nodal recurrence in levels IV or V. There was no statistically significant difference between both groups.

Conclusions: Neck dissection of levels I-III seems to be sufficient treatment in cases of unsuspicious lymph nodes in levels IV and V, even in cases of positive nodes in levels I-III if adjuvant radiation therapy is applied. However, 5-year-disease free survival rate is lower in patients with nodal metastases in levels IV and V than in patients with metastases located in levels I-III.