LAUSR

Dear Editor, We thank Dr. Abhinav Thaduri and colleagues for their valuable comments on our paper titled ‘‘Relevance of level IIb neck dissection in patients with head and neck squamous cell carcinomas’’ [1]. We agree that the retrospective design of our study represented a major limitation because it resulted in certain inconsistencies, and that the study population was heterogeneous and predominantly included hypopharyngeal and oropharyngeal cancers. Accordingly, we need to exercise caution while generalizing the applicability of IIb neck dissection to all subsets of head and neck squamous cell cancers, considering that different subsets exhibit different lymphatic drainage patterns. The aim of our study was to develop an alternative diagnostic tool and a therapeutic procedure that can identify the factors contributing to preservation of the function and performance of the spinal accessory nerve. Indeed, our study did not address the oncological (locoregional failure) and survival outcomes. In cases of therapeutic neck dissection, there is a strong association between the positivity of level IIa metastasis and level IIb involvement [2, 3]; therefore, we recommend the use of level IIb dissection if level IIa shows clinical node positivity. As pointed out by Dr. Thaduri, a randomized controlled trial (RCT) by Wang et al. [4] seems to clarify issues related to the oncological and functional safety of level IIb neck node preservation. However, it should be noted that this RCT only included early stage cancers. Further prospective, controlled studies with advanced-stage samples are warranted to determine the correlation between clinically determined and pathologically confirmed level IIb positivity.