{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T11:46:20Z","timestamp":1785843980427,"version":"3.56.0"},"reference-count":39,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to analyze risk factors for occult contralateral lymph node metastasis (LNM) in hypopharyngeal squamous cell carcinoma (HSCC) patients and provide evidence\u2010based recommendations for neck dissection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Retrospective analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Tertiary general hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 145 patients with HSCC who underwent primary tumor resection and neck dissection. Clinical and pathological data were collected, including tumor characteristics and lymph node status. Univariate and multivariate logistic regression analyses were conducted to identify risk factors for occult contralateral LNM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The overall occult contralateral LNM rate was 13.24% (n\u2009=\u200918\/136). In cN0 patients with Type A &amp; B(unilateral) tumors, occult contralateral LNM occurred in 9.30% (4\/43), specifically 12.90% (4\/31) for Type A and 0% (0\/12) for Type B. In cN+ patients with Type A &amp; B(unilateral) tumors, the rate was 15.05% (14\/93), with Type A(unilateral without midline involvement) at 12.5% (9\/72) and Type B(unilateral with midline involvement) at 23.81% (5\/21). Macroscopic extranodal extension (ENE) in the ipsilateral neck significantly affected contralateral occult metastasis. In contralateral clinically negative necks, occult metastases were primarily concentrated in levels II and III.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Central type tumors require bilateral neck dissection. For lateral lesions, contralateral levels II to III are dissected only if ipsilateral cN+, T3\u20104, or midline crossing is present. Macroscopic ENE in the ipsilateral neck significantly increases the risk of contralateral occult metastasis; intra\u2010operative identification warrants contralateral neck dissection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ohn.70373","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T11:20:45Z","timestamp":1785842445000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Is Bilateral Neck Dissection Always Necessary for Hypopharyngeal Squamous Cell Carcinoma? Risk Factors for Occult Contralateral Metastasis"],"prefix":"10.1002","author":[{"given":"Jiamei","family":"Wen","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery The First Affiliated Hospital of Chongqing Medical University Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuan","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery The First Affiliated Hospital of Chongqing Medical University Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhihai","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery The First Affiliated Hospital of Chongqing Medical University Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery The First Affiliated Hospital of Chongqing Medical University Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanshi","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery The First Affiliated Hospital of Chongqing Medical University Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery The First Affiliated Hospital of Chongqing Medical University Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery The First Affiliated Hospital of Chongqing Medical University Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengna","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery The First Affiliated Hospital of Chongqing Medical University Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaobo","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery The First Affiliated Hospital of Chongqing Medical University Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guohua","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery The First Affiliated Hospital of Chongqing Medical University Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"issue":"2","key":"e_1_2_9_2_1","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1080\/02648725.2023.2187876","article-title":"CDCA3 promotes the proliferation and migration of hypopharyngeal squamous cell carcinoma cells by activating the akt\/mTOR pathway","volume":"40","author":"Wu J","year":"2024","journal-title":"Biotechnol Genet Eng Rev"},{"key":"e_1_2_9_3_1","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.oraloncology.2018.09.025","article-title":"Hypopharyngeal cancer: a state\u2010of\u2010the\u2010art review","volume":"86","author":"Garneau JC","year":"2018","journal-title":"Oral Oncol"},{"issue":"1","key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1038\/s42003-025-07700-0","article-title":"Multi\u2010omics insights into the molecular signature and prognosis of hypopharyngeal squamous cell carcinoma","volume":"8","author":"Ren Y","year":"2025","journal-title":"Commun Biol"},{"issue":"11","key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"1462","DOI":"10.1016\/j.annonc.2020.07.011","article-title":"Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx: EHNS\u2010ESMO\u2010ESTRO clinical practice guidelines for diagnosis, treatment and follow\u2010up","volume":"31","author":"Machiels JP","year":"2020","journal-title":"Ann Oncol"},{"key":"e_1_2_9_6_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.oraloncology.2021.105183","article-title":"Assessment and treatment strategies for occult contralateral lymph node metastasis in hypopharyngeal squamous cell carcinoma patients with ipsilateral node\u2010positive necks","volume":"114","author":"Heng Y","year":"2021","journal-title":"Oral Oncol"},{"issue":"3","key":"e_1_2_9_7_1","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1007\/s00405-011-1694-8","article-title":"Chemoradiation for advanced hypopharyngeal carcinoma: a retrospective study on efficacy, morbidity and quality of life","volume":"269","author":"Keereweer S","year":"2012","journal-title":"Eur Arch Otorhinolaryngol"},{"issue":"1","key":"e_1_2_9_8_1","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1056\/NEJMra1715715","article-title":"Head and neck cancer","volume":"382","author":"Chow LQM.","year":"2020","journal-title":"N Engl J Med"},{"issue":"4","key":"e_1_2_9_9_1","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/j.jcms.2024.12.017","article-title":"Impact of different staging methods of lymph nodes metastases on prognosis in advanced hypopharyngeal squamous cell carcinoma","volume":"53","author":"Wang T","year":"2025","journal-title":"J Cranio\u2010Maxillofac Surg"},{"issue":"8","key":"e_1_2_9_10_1","doi-asserted-by":"crossref","DOI":"10.1088\/1361-6560\/adc235","article-title":"Modelling occult lymph node metastases in HNSCC patients with a trinary state hidden markov model","volume":"70","author":"P\u00e9rez Haas Y","year":"2025","journal-title":"Phys Med Biol"},{"issue":"4","key":"e_1_2_9_11_1","first-page":"2805","article-title":"Pre\u2010operative evaluation of cervical adenopathies in tumours of the upper aerodigestive tract","volume":"18","author":"Giancarlo T","year":"1998","journal-title":"Anticancer Res"},{"issue":"3","key":"e_1_2_9_12_1","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1016\/j.radonc.2018.04.020","article-title":"Implications of improved diagnostic imaging of small nodal metastases in head and neck cancer: radiotherapy target volume transformation and dose de\u2010escalation","volume":"128","author":"den Bosch S","year":"2018","journal-title":"Radiother Oncol"},{"issue":"5","key":"e_1_2_9_13_1","doi-asserted-by":"crossref","first-page":"512","DOI":"10.5114\/jcb.2020.100386","article-title":"The role of imaging in head and neck cancer: an overview of different imaging modalities in primary diagnosis and staging of the disease","volume":"12","author":"Vishwanath V","year":"2020","journal-title":"J Contemp Brachytherapy"},{"key":"e_1_2_9_14_1","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1007\/s40487-025-00348-0","article-title":"When neck dissection is not indicated in the treatment of the clinically node\u2010negative head and neck squamous cell carcinoma","volume":"13","author":"Hamoir M","year":"2025","journal-title":"Oncol Ther"},{"key":"e_1_2_9_15_1","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.oraloncology.2019.01.016","article-title":"Elective neck dissection in oral squamous cell carcinoma: past, present and future","volume":"90","author":"Bree R","year":"2019","journal-title":"Oral Oncol"},{"key":"e_1_2_9_16_1","unstructured":"National Comprehensive Cancer NetworkHead and Neck Cancers (Version 4.2025). Published online June 20 2025.https:\/\/nccn.medlive.cn\/"},{"issue":"6","key":"e_1_2_9_17_1","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1056\/NEJMoa1506007","article-title":"Elective versus therapeutic neck dissection in node\u2010negative oral cancer","volume":"373","author":"D'Cruz AK","year":"2015","journal-title":"N Engl J Med"},{"issue":"7","key":"e_1_2_9_18_1","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1001\/archotol.1994.01880310005001","article-title":"Use of decision analysis in planning a management strategy for the stage NO neck","volume":"120","author":"Weiss MH","year":"1994","journal-title":"Arch Otolaryngol Head Neck Surg"},{"issue":"6","key":"e_1_2_9_19_1","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1002\/hed.23689","article-title":"Current philosophy in the surgical management of neck metastases for head and neck squamous cell carcinoma","volume":"37","author":"Coskun HH","year":"2015","journal-title":"Head Neck"},{"issue":"8","key":"e_1_2_9_20_1","doi-asserted-by":"crossref","first-page":"1210","DOI":"10.1002\/hed.21505","article-title":"Management of the clinically negative neck in early\u2010stage head and neck cancers after transoral resection","volume":"33","author":"Rodrigo JP","year":"2011","journal-title":"Head Neck"},{"key":"e_1_2_9_21_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.oraloncology.2025.107430","article-title":"Postoperative complications of neck dissection for head and neck squamous cell carcinoma: a systematic review and meta\u2010analysis","volume":"167","author":"Mak CH","year":"2025","journal-title":"Oral Oncol"},{"issue":"3","key":"e_1_2_9_22_1","first-page":"203","article-title":"American Cancer Society head and neck cancer survivorship care guideline","volume":"66","author":"Cohen E.E.","year":"2016","journal-title":"CA Cancer J Clin"},{"issue":"1","key":"e_1_2_9_23_1","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1186\/s12903-022-02288-x","article-title":"Postoperative radiotherapy may not be necessary for locally advanced head and neck squamous cell carcinoma: a case\u2010match multicentre study","volume":"22","author":"Ren ZH","year":"2022","journal-title":"BMC Oral Health"},{"issue":"4","key":"e_1_2_9_24_1","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1016\/S0360-3016(97)00025-4","article-title":"Metastatic carcinoma in the cervical lymph nodes from an unknown primary site: results of bilateral neck plus mucosal irradiation vs. ipsilateral neck irradiation","volume":"37","author":"Reddy SP","year":"1997","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"11","key":"e_1_2_9_25_1","doi-asserted-by":"crossref","first-page":"3965","DOI":"10.1007\/s00405-017-4724-3","article-title":"Frequency of bilateral cervical metastases in hypopharyngeal squamous cell carcinoma: a retrospective analysis of 203 cases after bilateral neck dissection","volume":"274","author":"Olzowy B","year":"2017","journal-title":"Eur Arch Otrhinolaryngol"},{"issue":"3","key":"e_1_2_9_26_1","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1080\/000164801300102671","article-title":"Selective neck dissection for hypopharyngeal cancer in the clinically negative neck: should it be bilateral?","volume":"121","author":"Ferlito A","year":"2001","journal-title":"Acta Otolaryngol"},{"issue":"11","key":"e_1_2_9_27_1","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.1002\/hed.20907","article-title":"Nodal metastases at level IIb during neck dissection for head and neck cancer: clinical and pathologic evaluation","volume":"30","author":"Santoro R","year":"2008","journal-title":"Head Neck"},{"issue":"5","key":"e_1_2_9_28_1","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1002\/hed.2880160502","article-title":"Medial vs lateral wall pyriform sinus carcinoma: Implications for management of regional lymphatics","volume":"16","author":"Johnson JT","year":"1994","journal-title":"Head Neck"},{"issue":"9","key":"e_1_2_9_29_1","doi-asserted-by":"crossref","first-page":"3515","DOI":"10.1007\/s00405-021-06648-1","article-title":"A nomogram for predicting occult lymph node metastasis in early hypopharyngeal cancer with cN0","volume":"278","author":"Yuan X","year":"2021","journal-title":"Eur Arch Otrhinolaryngol"},{"issue":"1","key":"e_1_2_9_30_1","first-page":"E1969","article-title":"Pattern of lymph node metastasis in hypopharyngeal squamous cell carcinoma and indications for level VI lymph node dissection","volume":"38","author":"Chung EJ","year":"2016","journal-title":"Head Neck"},{"issue":"2","key":"e_1_2_9_31_1","first-page":"93","article-title":"The eighth edition AJCC cancer staging manual: Continuing to build a bridge from a population\u2010based to a more \u201cpersonalized\u201d approach to cancer staging","volume":"67","author":"Amin MB","year":"2017","journal-title":"CA Cancer J Clin"},{"issue":"2","key":"e_1_2_9_32_1","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1002\/hed.27978","article-title":"The prognostic importance of radiologic extranodal extension in hypopharyngeal carcinoma","volume":"47","author":"Liao YH","year":"2025","journal-title":"Head Neck"},{"issue":"6","key":"e_1_2_9_33_1","doi-asserted-by":"crossref","first-page":"1769","DOI":"10.1002\/hed.28090","article-title":"Clinicopathological significance of extranodal extension in hypopharyngeal and laryngeal squamous cell carcinoma","volume":"47","author":"Kijima N","year":"2025","journal-title":"Head Neck"},{"issue":"1","key":"e_1_2_9_34_1","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-025-99978-7","article-title":"A probabilistic model of bilateral lymphatic spread in head and neck cancer","volume":"15","author":"Ludwig R","year":"2025","journal-title":"Sci Rep"},{"issue":"5","key":"e_1_2_9_35_1","first-page":"404","article-title":"[clinicopathologic features and risk factors of bilateral cervical lymph node metastasis in head and neck squamous cell carcinoma]","volume":"49","author":"Di B","year":"2014","journal-title":"Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi"},{"issue":"11","key":"e_1_2_9_36_1","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1080\/00016480701230951","article-title":"Is dissection of levels 4 and 5 justified for cN0 laryngeal and hypopharyngeal cancer","volume":"127","author":"Katilmi\u015f H","year":"2007","journal-title":"Acta Otolaryngol"},{"key":"e_1_2_9_37_1","doi-asserted-by":"crossref","DOI":"10.3389\/fonc.2024.1330276","article-title":"Development and validation of a diagnostic model for predicting cervical lymph node metastasis in laryngeal and hypopharyngeal carcinoma","volume":"14","author":"Wu X","year":"2024","journal-title":"Front Oncol"},{"issue":"6","key":"e_1_2_9_38_1","doi-asserted-by":"crossref","first-page":"665","DOI":"10.3109\/00016489.2011.554437","article-title":"Necessity of level IV dissection in cN0 hypopharyngeal carcinoma","volume":"131","author":"Shin YS","year":"2011","journal-title":"Acta Otolaryngol"},{"key":"e_1_2_9_39_1","doi-asserted-by":"crossref","DOI":"10.3389\/fonc.2021.727991","article-title":"Different primary sites of hypopharyngeal cancer have different lymph node metastasis patterns: a retrospective analysis from multi\u2010center data","volume":"11","author":"Zhang X","year":"2021","journal-title":"Front Oncol"},{"key":"e_1_2_9_40_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.radonc.2025.111319","article-title":"Patterns of lymphatic spread in hypopharyngeal squamous cell carcinoma\u2014findings from a multicenter study","volume":"214","author":"Looman EL","year":"2026","journal-title":"Radiother Oncol"}],"container-title":["Otolaryngology\u2013Head and Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ohn.70373","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ohn.70373","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ohn.70373","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T11:20:54Z","timestamp":1785842454000},"score":1,"resource":{"primary":{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/10.1002\/ohn.70373"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,4]]},"references-count":39,"alternative-id":["10.1002\/ohn.70373"],"URL":"https:\/\/doi.org\/10.1002\/ohn.70373","archive":["Portico"],"relation":{},"ISSN":["0194-5998","1097-6817"],"issn-type":[{"value":"0194-5998","type":"print"},{"value":"1097-6817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,4]]},"assertion":[{"value":"2025-10-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"ohn.70373"}}