Is Level IIB Dissection Necessary in the Clinically N0 Neck? A Systematic Review and Meta-Analysis in Head and Neck Squamous Cell Carcinoma.
Head NeckJul 13, 2026 (epub)
Matteo Fermi, Francesco Chiari, Gerardo Petruzzi et al.
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In 30 seconds
This systematic review and meta-analysis evaluated the necessity of level IIB dissection in clinically node-negative (cN0) head and neck squamous cell carcinoma (HNSCC). Analyzing 35 studies, the pooled prevalence of level IIB metastases was found to be low: 1.7% for laryngeal, 1.2% for oral cavity, 2.6% for oropharyngeal, and 2.5% for hypopharyngeal cancers. The findings suggest that routine dissection may not be required in low-risk patients.
Key findings
- Pooled prevalence of level IIB metastasis was 1.7% for laryngeal cancer.
- Oropharyngeal cancer showed a 2.6% prevalence of level IIB metastasis.
- SAN-related morbidity was reported up to 4%, with shoulder impairment in 2% of dissections.
- Level IIB involvement was consistently lower than adjacent nodal levels.
Why it matters
Understanding the low prevalence of level IIB metastasis in cN0 HNSCC can guide surgical decision-making, potentially reducing unnecessary procedures and associated morbidity in low-risk patients.