SynthesisHead & neck2026
Is Level IIB Dissection Necessary in the Clinically N0 Neck? A Systematic Review and Meta-Analysis in Head and Neck Squamous Cell Carcinoma.
Synthesis in Head & neck, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
2 citing papers in PubMed.
- Implementation of ultrasound surveillance following negative sentinel lymph node biopsy in early oral squamous cell carcinoma: a retrospective cohort study.Oral and maxillofacial surgery · 2026Article
- Longitudinal spinal accessory nerve conduction after nerve-preserving neck dissection in oral cavity squamous cell carcinoma: a prospective hierarchical mixed-effects cohort study.Oral and maxillofacial surgery · 2026Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe management of sublevel IIB during elective neck dissection (END) for clinically node-negative (cN0) head and neck squamous cell carcinoma (HNSCC) remains debated. Although level IIB metastases are considered uncommon, omission of this sublevel must be balanced against the risk of undertreating occult node metastasis and the potential morbidity related to spinal accessory nerve (SAN) manipulation.
methodsA systematic review was conducted according to PRISMA 2020 guidelines. Embase, PubMed, Scopus, and Cochrane Library were searched for studies published until April 30, 2026. Eligible studies included adult patients with cN0 laryngeal (LSCC), oral cavity (OCSCC), oropharyngeal (OPSCC), or hypopharyngeal squamous cell carcinoma (HSCC) undergoing END with level-specific pathological assessment, including sublevel IIB. A random-effects meta-analysis of proportions was performed to estimate the pooled prevalence of level IIB metastases by tumor subsite.
resultsThirty-five studies were included. The pooled prevalence of level IIB metastasis was 1.7% for LSCC, 1.2% for OCSCC, 2.6% for OPSCC, and 2.5% for HSCC. Across subsites, level IIB showed consistently lower metastatic involvement than adjacent nodal levels. In LSCC and OCSCC, exploratory study-level stratification suggested persistently low level IIB involvement even in cohorts enriched with advanced-stage tumors. SAN-related morbidity was inconsistently reported, with available studies showing rates up to 4%, and postoperative shoulder impairment reported in up to 2% of dissections.
conclusionsLevel IIB demonstrates a consistently low prevalence of occult metastasis in cN0 HNSCC, particularly in LSCC and OCSCC. These findings suggest that routine level IIB dissection may not be necessary in carefully selected low-risk patients. Surgical decision-making should be individualized according to tumor subsite, stage, and intraoperative findings.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.