Research progress on the neck management of oral squamous cell carcinoma with clinically node-positive neck / 口腔疾病防治

@#Oral squamous cell carcinoma (OSCC) is the most common malignant tumor in the oral and maxillofacial regions. Cervical lymph node metastasis is not only an important biological behavior of oral cancer but also an important factor affecting the prognosis of oral cancer patients. As neck dissection is the most commonly used method of neck management, the appropriate choice of surgical procedure is very important. The current view is that radical neck dissection or modified radical neck dissection can be used for patients with clinically node-positive neck (cN+), while selective neck dissection can be used for patients with clinically node-negative neck (cN0). In recent years, selective neck dissection has been increasingly popularized and applied. Its implications are also gradually expanding from cN0 to cN+. However, there is still no consensus on whether selective neck dissection can also be used in patients with cN+ necks. This article reviews the clinical studies on the neck management of cN+ OSCC patients in recent years, analyzes the effects of different neck dissections on the prognosis of cN+ OSCC patients, and summarizes the treatment principles of neck management.

Hallazgo incidental de metástasis de carcinoma de tiroides en disección de cuello por carcinoma de laringe / Incidental finding of metastasis due to thyroid´s carcinoma in a neck dissection by larynx carcinoma

RESUMEN Introducción: El fenómeno de las neoplasias primarias múltiples se ha descrito en cabeza y cuello, de forma metacrónica y sincrónica. Caso clínico: Hombre de 54 años, piel negra y procedencia rural con carcinoma escamoso de laringe T3N1M0, etapa III, que en disección de cuello se encontró incidentalmente metástasis ganglionar de carcinoma papilar de tiroides, sin evidencia clínica de lesión tiroidea. Luego se realizó ecografía y gammagrafía de la glándula cuyos resultados no mostraron alteración alguna. Conclusiones: El carcinoma de tiroides es hallado incidentalmente en el espécimen resecado después de cirugía por cáncer de cabeza y cuello en 0,3 - 1,9 por ciento de los pacientes. Por este motivo debe evaluarse bien la glándula tiroides previa cirugía de cabeza y cuello(AU)

ABSTRACT Introduction: The phenomenon of multiple primary neoplasms has been described in the head and neck in a synchronous and metachronous way. Clinical case: A 54 years old man, black skin and rural origin with a T3N1M0 larynx squamous cell carcinoma, stage III that in a neck dissection was incidentally found a node metastasis of papillary thyroid carcinoma, without clinical evidence of thyroid lesion. This was followed by ultrasound and nuclear scan of the gland, whose results did not show any alteration. Conclusions: The thyroid carcinoma is found incidentally in the resected specimen after surgery by head and neck cancer in 0.3 - 1.9 percent of patients. The thyroid gland must be well assessed after head and neck surgery(AU)

Comparison of Bipolar Vessel Sealing System versus Suture Ligation in Selective Neck Dissection in Patients with Oral Cancer

Introduction: Major head and neck surgery involve dissections close to crucial structures such as nerves and vessels. For this reason, it is very important to use safe instruments for dissection and hemostasis. In a wide variety of surgical procedures, advanced vessel sealing devices are replacing traditional techniques for vessel ligation. Aim: Our study aimed to compare the bipolar vessel sealing system versus suture ligation in selective neck dissection in patients with oral cancer. Methods: This prospective comparative study was conducted to compare the outcome of the bipolar vessel sealing system versus suture ligation in selective neck dissection in patients with oral cancer. Out of 40 patients enrolled in the study, 20 patients were in Group A (bipolar vessel sealing system) and 20 patients in Group B (Suture ligation). The outcome measures recorded were blood loss, operating time, duration of hospital stay, pre-operative blood transfusion, Fromme’s surgical field scale, post-operative pain, and drainage volume. Treatment protocol and follow-up protocol were followed and the results were statistically analyzed and discussed. Results: Out of 40 patients, 20 patients had bipolar vessel sealing system and 20 patients had suture ligation. In bipolar vessel sealing system of 20 patients, 12 patients were male and 8 patients were female, mean value of blood loss is 26.84 ± 22.34 ml, operating time is 48.56 ± 5.48 min, duration of hospital stay is 12.92 ± 1.28 days, mean value of post-operative pain in day 0 is 3.5 ± 1, day 1 is 3.1 ± 1, day 2 is 1.8 ± 0.5, and day 3 is 1.1 ± 0.5, and drainage volume (ml) in 24 h is 72.48 ± 28.46, 48 h is 24.57 ± 18.29, and 72 h is 7.24 ± 6.7. In suture ligation of 20 patients, 15 patients were male and 5 patients were female, mean value of blood loss is 39.28 ± 16.44 ml, operating time is 54.22 ± 4.14 min, duration of hospital stay is 13.87 ± 1.42 days, mean value of post-operative pain in day 0 is 4.01 ± 0.9, day 1 is 3.8 ± 1.1, day 2 is 2.4 ± 0.6, and day 3 is 1.6 ± 0.8, and drainage volume (ml) in 24 h is 98.28 ± 36.87, 48 h is 41.28 ± 21.24, and 72 h is 18.29 ± 9.45. Conclusion: Bipolar vessel sealing system is more efficacious in terms of reducing blood loss, operating time, and better surgical field than conventional suture ligation. Thus, bipolar vessel sealing system is more advantageous compared to the traditional techniques, from both a clinical and economic point of view.

Neck dissection for oral squamous cell carcinoma: our experience and a review of the literature

OBJECTIVES: This article describes our experience with neck dissection in 10 patients with oral squamous cell carcinoma. MATERIALS AND METHODS: Between January 2007 and October 2009, 10 patients underwent primary surgery for the treatment of squamous cell carcinoma of the oral cavity. For patients with N0 disease on clinical exam, selective neck dissection (SND [I-III]) was performed. In patients with palpable cervical metastases (N+), modified radical neck dissections were performed, except in one patient in whom SND (I-III) was performed. The histopathologic reports were reviewed to assess the surgical margins, the presence of extra-capsular spread, perineural invasion, and lymphatic invasion. RESULTS: On histopathologic examination, positive soft tissue margins were found in three patients, and regional lymph node metastases were present in five of the ten patients. Perineural invasion was noted in five patients, and extra nodal spread was found in four patients. Regional recurrence was seen in two patients and loco-regional recurrence plus distant metastasis to the tibia was observed in one patient. During the study period, three patients died. Seven patients remain free of disease to date. CONCLUSION: Histopathological evaluation provides important and reliable information for disease staging, treatment planning, and prognosis. The philosophy of neck dissection is evolving rapidly with regard to the selectivity with which at-risk lymph node groups are removed. The sample size in the present study is small, thus, caution should be employed when interpreting these results.

Conversion from Selective to Comprehensive Neck Dissection: Is It Necessary for Occult Nodal Metastasis? 5-Year Observational Study

OBJECTIVES: To compare the therapeutic results between selective neck dissection (SND) and conversion modified radical neck dissection (MRND) for the occult nodal metastasis cases in head and neck squamous cell carcinoma. METHODS: Forty-four cases with occult nodal metastasis were enrolled in this observational cohort study. For twenty-nine cases, SNDs were done and for fifteen cases, as metastatic nodes were found in the operative field, conversion from selective to MRNDs type II were done. Baseline data on primary site, T and N stage, extent of SND, extracapsular spread of occult metastatic node and type of postoperative adjuvant therapy were obtained. We compared locoregional control rate, overall survival rate and disease specific survival rate between two groups. RESULTS: Among the 29 patients who underwent SND, only one patient had a nodal recurrence which occurred in the contralateral undissected neck. On the other hand, among the 15 patients who underwent conversion MRND, two patients had nodal recurrences which occurred in previously undissected neck. According to the Kaplan Meier survival curve, there was no statistically significant difference for locoregional control rate, overall survival rate and disease specific survival rate between two groups (P=0.2719, P=0.7596, and P=0.2405, respectively). CONCLUSION: SND is enough to treat occult nodal metastasis in head and neck squamous cell carcinoma and it is not necessary to convert from SND to comprehensive neck dissection.

Selective Neck Dissection for Clinically Node-Positive Oral Cavity Squamous Cell Carcinoma

PURPOSE: The treatment of a clinically node-positive (cN+) neck is important in the management of oral cavity squamous cell carcinoma (OSCC). However, the extent of neck dissection (ND) remains controversial. The purpose of our study was to evaluate whether level IV or V can be excluded in therapeutic ND for cN+ OSCC patients. MATERIALS AND METHODS: We performed a retrospective chart review of 92 patients who underwent a comprehensive or selective ND as a therapeutic treatment of cN+ OSCC from January 1993 to February 2009. RESULTS: The incidence rate of metastasis to level IV or V was 22% (16 of 72) on the ipsilateral neck. Of 67 cases without clinically suspicious nodes at level IV or V, 11 cases (16%, 11 of 67) had pathologically proven lymphatic metastasis to level IV or V. Only a nodal staging above N2b was significantly relevant with the higher rate of level IV or V lymph node metastasis (p=0.025). In this series, selective ND, combined with proper adjuvant therapy, achieved regional control and survival rates comparable to comprehensive ND in patients under the N stage of cN2a OSCC. CONCLUSION: In conclusion, level IV and V patients can avoid recurrence under cN2a OSCC.

Investigation of selective neck dissection for differentiated thyroid carcinoma / 中华内分泌外科杂志

Objective To investigate the treatment method of selective neck dissection(SND). Methods 68 cases patients with differentiated thyroid carcinoma were cured by selective neck dissection. Results The rate of lymph node diversion in 68 cases patients was 60.3%, among the diversion rate of lymph node in VI area was 51%. There were not patients who happend permanent damagement of laryngeal nerve and hypoparathyroidism. Conclusions It is available that selective neck dissection cures differentiated thyroid carcinoma.

Surgical Treatment of Tuberculous Cervical Abscess / 대한이비인후과학회지

BACKGROUND: Tuberculous cervical lymphadenitis is presently well controlled with surgical treatment and medication. In the case of tuberculous cervical abscess, variable treatment modalities are introduced by many authors. MATERIALS AND METHODS: In our cases, surgical treatments such as incision and drainage, mass excision and selective neck dissection, combined with chemotherapy were performed in 15 patients with tuberculous cervical abscesses. The results were reviewed retrospectively. RESULTS: The results showed that in cases of simple drainage, a second operation was required to excise the residual infected tissues which were caused by persistent sinus discharge. In the case of mass excision, some local problems occurred, albeit less commonly. In both groups, local wound problems took up a lot of time and effort for treatment. In cases of selective neck dissection, which is a more wide excision around the abscess, there were no recurrence nor any local wound problems. Tuberculous cervical abscess treated with selective neck dissection showed better surgical outcomes with low morbidity and no severe complications. CONCLUSIONS: Therefore, we recommend a wide excision as a therapeutic modality in cases of tuberculous cervical abscess.

A Clinical Study on Selective Neck Dissection / 대한이비인후과학회지

BACKGROUND: Selective neck dissection has been performed as a primary purpose of management for the lymph node groups that are at highest risk of containing metastasis according to the location of the primary tumor. OBJECTIVES: We were to evaluate the clinical application and effectiveness of selective neck dissection through analysis of the medical records about treatment results and postoperative recurrences. MATERIALS AND METHOD: The medical records of 61 patients who had 86 neck dissections performed at the Kangnam St. Mary's Hospital during the period of 1993 through 1995 were reviewed. RESULTS: Forty four selective neck dissections had been performed in 35 patients. Sites of primary tumor were 22 larynx cancers(62.9%), 5 thyroid cancers(14.3%), 4 tongue cancers(11.4%), 2 lip cancers(5.7%), 1 oropharynx cancer(2.9%) and 1 malignant melanoma(2.9%). The types of neck dissection were 29 lateral neck dissections(65.9%), 9 supraomohyoid neck dissections(19.2%), 5 anterior neck dissections(11.4%), and 1 posterolateral neck dissection(2.3%). Elective neck dissections were performed on 26 Cases(59.1%). Lymph nodes were histologically positive in 10 of 18 therapeutic neck Dissections(55.6%) and in 5 of 26 electeve neck dissections(19.2%). Recurrence in the dissected neck occured in two cases(4..5%) of selective neck dissections. Both of the two cases were larynx cancer, which developed concomitant primary and neck recurrence after lateral neck dissection. CONCLUSION: Selective neck dissection was effective approach to neck management of head and neck cancer patients.