Is Level V Neck Dissection Necessary in Primary Parotid Cancer?

Objectives/HypothesisThis study aims to evaluate the pattern of nodal metastasis to level V in parotid cancer and to examine the clinical value of level V neck dissection (LVND). Study DesignRetrospective cohort study. MethodsRetrospective chart review of 86 patients (47 N0 nodal metastasis [N0] neck and 39 positive nodal metastasis [N+] neck) who received parotidectomy and neck dissection was performed. The prevalence of pathological nodal metastasis in level V neck was evaluated and correlated with locoregional recurrence. ResultsLVND was performed in 10.6% and 28.2% of patients with clinical NO (cN0) and cN(+) neck disease, respectively. The prevalence of pathological positive nodal metastasis was 0% (cN0) and 81.8% (cN(+)). In patients with cN0 neck, the rate of recurrence in level V was 6%. ConclusionIn our patient cohort with predominantly high-grade parotid cancer, LVND was necessary in patients with cN(+) neck because there was a high likelihood for pathologically positive nodal metastasis. In patients with cN0 neck, the rate of recurrence in level V was low enough not to warrant a routine inclusion of LVND. Level of Evidence4. Laryngoscope, 125:118-121, 2015