OBJECTIVETo analyze the prevalence and distribution of cervical node metastases in squamous cell carcinoma of hypopharynx and evaluate the efficacy of selective neck dissection (SND) on the treatment of the neck metastases.

METHODSA retrospective review was performed for 63 patients with squamous cell carcinoma of hypopharynx from January 1990 to December 2004. Lymph nodes were clinically negative in 17 patients and positive in 46 patients. There were 15 unilateral SND, 22 bilateral SND and 16 modified radical neck dissections (MRND). Ipsilateral MRND or radical neck dissections (RND) and contralateral SNDs were performed in 10 cases. Forty-eight patients were followed up and the follow-up interval ranged from 24 to 143 months and the median was 41 months.

RESULTSLymph nodes were pathologically negative (pN0) in 22 and positive (pN +) in 41 patients. A total of 106 positive nodes were found in 95 neck dissections. The distribution of the positive nodes were as follows: Level II 47.2% (50/106), Level III33.0% (35/106), Level IV11.3% (12/106), Level V2.8% (3/106), Level VI 5.7% (6/106). Contralateral nodal metastases and recurrence were observed in both cN0 and cN + cases. There were 18 neck recurrent cases. High incidence of neck recurrence after SND was found in level II and III. The 3-year estimated survival rate analysis were 58.1% for the pN0 and 44.9% for pN1 and 41.1% for pN2 patients. Cox regression analysis suggested N stage was the most important prognostic factor. The risk ratio was 1.7 in pN1 and 2.2 in pN2.

CONCLUSIONSLymphatic metastases was the most significant prognostic factor of hypopharyngeal squamous cell carcinoma. Bilateral selective neck dissection, when carefully indicated, offers functional advantages without oncologic compromise.