Central Compartment Neck Dissection in Laryngeal and Hypopharyngeal Squamous Cell Carcinoma: Clinical Considerations

Simple Summary The central compartment of the neck is not cleared during a comprehensive neck dissection, which usually encompasses neck levels I to V. When involved by clinically evident lymph node metastases, central neck compartment dissection is mandatory; on the other hand, precise indications regarding the elective surgical management of occult lymph node metastases at this level are still a matter of debate. Laryngeal and hypopharyngeal squamous cell carcinomas can spread to regional lymph nodes located in the central neck compartment. This anatomic region contains the laryngeal nerves, the thyroid, and parathyroid glands, and its boundaries are represented by major vessels. This paper will focus on relevant clinical aspects that must be considered in order to formulate a judicious balance between the probability of dealing with occult disease and the possibility of being confronted with unnecessary iatrogenic risks. Metastatic lymph node involvement represents the most relevant prognostic factor in head and neck squamous cell carcinomas (HNSCCs), invariably affecting overall survival, disease-specific survival, and relapse-free survival. Among HNSCCs, laryngeal and hypopharyngeal cancers are known to be at highest risk to metastasize to the central neck compartment (CNC). However, prevalence and prognostic implications related to the CNC involvement are not well defined yet, and controversies still exist regarding the occult metastasis rate. Guidelines for the management of CNC in laryngeal and hypopharyngeal cancers are vague, resulting in highly variable selection criteria for the central neck dissection among different surgeons and institutions. With this review, the authors intend to reappraise the existing data related to the involvement of CNC in laryngeal and hypopharyngeal malignancies, in the attempt to define the principles of management while highlighting the debated aspects that are lacking in evidence and consensus. Furthermore, as definition and boundaries of the CNC have changed over the years, an up-to-date anatomical-surgical description of the CNC is provided.