Indications for Neck Dissection with Hypopharyngeal Cancers

Unlike glottic cancer, hypopharyngeal cancers have a high propensity for
- Occult cervical nodal metastases
- Paratracheal nodal metastases (Level VI)
- Bilateral nodal metastases
T1 (most) and T2-4 clinically N0 neck
- Elective neck dissection Levels II– IV
- Level VI (pre- and paratracheal nodes).…requires thyroid lobectomy
- Contralateral SND Levels II– IV
  - Medial wall of piriform fossa / aryepiglottic fold
  - Postcricoid
  - Posterior pharyngeal wall
- Convert to MND if suspicious nodes in neck (+/- frozen section)
- Level VI (pre- and paratracheal nodes) with subglottic extension or extension to piriform fossa…requires thyroid lobectomy
Clinically N+ neck
- Modified radical neck dissection (MND) / Radical neck dissection (RND)
- Contralateral END Levels II– IV
  - Medial wall of piriform fossa / aryepiglottic fold
  - Postcricoid
  - Posterior pharyngeal wall