Level V involvement in patients with early T-stage, node-positive oropharyngeal carcinoma

Objectives/Hypothesis: To assess the risk of level V nodal involvement for early T-stage and node positive oropharyngeal squamous cell carcinoma (ORO-SCC). Methods: Retrospective analysis performed on patients with ORO-SCC and clinically positive lymph nodes who had undergone upfront elective dissection of level V before definitive chemoradiotherapy. Pathological data collected and prevalence of involvement of level V determined. Results: A total of 119 patients had level V dissection. The prevalence of pathologically positive lymph nodes in level V was 3.4% (4/119). Moreover, it was observed only in the presence of pathological involvement of multiple other nodal levels (4/52 patients, 7.7% vs. 0/67 in patients with a single nodal station involved, χ² P = .02). Conclusions: Subclinical involvement of level V in ORO-SCC is rare, especially in the presence of disease confined to a single nodal level. The present data do not support its dissection after primary chemoradiotherapy.