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Cervical level IIb metastases in squamous cell carcinoma of the oral cavity: a systematic review and meta-analysis

Authors Kou Y, Zhao T, Huang S, Liu J, Duan W, Wang Y, Wang Z, Li D, Ning C, Sun C

Received 6 June 2017

Accepted for publication 1 August 2017

Published 11 September 2017 Volume 2017:10 Pages 4475—4483


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Carlos E Vigil

Yurong Kou,1,* Tengfei Zhao,2,* Shaohui Huang,2 Jie Liu,3 Weiyi Duan,2 Yunjing Wang,2 Zechen Wang,2 Delong Li,2 Chunliu Ning,2 Changfu Sun2

1Department of Oral Biology, School of Stomatology, China Medical University, Shenyang, Liaoning, People’s Republic of China; 2Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Shenyang, Liaoning, People’s Republic of China; 3Centre of Science Experiment, China Medical University, Shenyang, Liaoning, People’s Republic of China

*These authors contributed equally to this work

Purpose: The aim of this study was to clarify whether level IIb dissection should be performed or avoided in the treatment of oral squamous cell carcinoma by meta-analysis.
Materials and methods: Articles that were published before June 2017 were searched electronically in four databases (Web of Science, PubMed, Ovid and China National Knowledge Infrastructure) without any date or language restrictions by two independent reviewers. Abstracts and full-text papers which investigated the cervical metastases to level IIb from primary head and neck cancers and were deemed potentially relevant were screened. Data were analyzed using RevMan 5.3.
Results: Four hundred and fifty-five abstracts and 129 full-text papers were screened, and 22 studies were included in the analysis. Among the 2001 patients included, 112 patients had level IIb metastases, the pooled frequency of which was 6% (95% confidence interval [CI]: 4.0–7.0). Among the 400 patients with tongue squamous cell carcinoma from 12 studies, 37 patients had level IIb metastases, the pooled incidence of which was 7% (95% CI: 5.0–10.0). Metastases to level IIb always went together with level IIa, and only three patients were found to have isolated level IIb metastases without involving the other levels.
Conclusion: Due to the low frequency of level IIb nodal metastases in oral squamous cell carcinoma patients and rare occurrence of isolated level IIb, level IIb dissection could be avoided when the primary lesions were in early stages (T1 and T2), with the exception of tongue cancer. It is recommended to dissect level IIb tongue cancers without considering the stages of primary lesions and the lymph nodes status. It is also suggested that level IIb dissection should be performed in patients preoperatively or intraoperatively found with multilevel neck metastasis, especially level IIa metastasis.

Keywords: level IIb, meta-analysis, neck dissection, oral squamous cell carcinoma, submuscular recess

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