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Abstract Introduction Selective neck dissection inclinically node-negative neckisconsidered the standard of care for oral squamous cell carcinomas (SCCs). Controversy still prevailsinnode-positive disease regarding the extent of neck dissection. In our part of the world, comprehensive neck dissection is mostly considered to be the minimal optimal treatment for palpable neck disease. Objective To compare regional control and disease-specific survival between clinically node-positive and node-negative patients undergoing selective neck dissection for oral SCC. Methods This was a retrospective cohort study conducted in the department of ENT, Head and Neck surgery at a tertiary care hospital. All patients with biopsy-proven oral and lip SCC, with or without nodal disease, who underwent selective neck dissection between April 2006 and July 2015 were included in the study. Results During the study period, 111 patients with oral SCC underwent selective neck dissection, of whom 71 (62%) were clinically node-negative and 40 (38%) patients had clinically positive nodes in the neck. The mean follow-up was 16.62 months (standard deviation [SD]: 17.03). The overall regional control rates were 95 versus 96% for clinical negative versus positive nodes, respectively (p = 0.589). The disease-specific survival was 84.5% in the node negative group versus 82.5% in the node-positive group (p = 0.703). Conclusion Selective neck dissection in node-positive neck oral SCC has similar regional control rates when compared with node-negative neck SCC. The difference in disease-specific survival between the two groups is also not significant.
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No Brasil, registros hospitalares de câncer revelam a boca como a oitava localização mais frequente de tumores malignos, sendo a maioria delas diagnosticada em estádio avançado. Em países desenvolvidos, as taxas de diagnóstico tardio são cerca de 40%. O diagnóstico e tratamento precoces representam mais chance de cura, baixo custo emenos morbidade. Este artigo objetiva verificar as possíveis razões de atraso no diagnóstico e tratamento das neoplasias bucais e refletir sobre os seus motivos. Os termos neoplasias bucais, diagnóstico, epidemiologia e terapia foram introduzidos nas bases de dados MEDLINE, LILACS e SCIELO. Foram analisados 31 estudos, entre 1995 e 2011,que discorriam sobre o atraso diagnóstico em relação ao paciente, ao profissional e ao sistema de saúde. Observou-se que o atraso diagnóstico associou-se a: a) pacientes: solteiros, etilistas e com medo do diagnóstico; b) médico: pouco conhecimento sobre o assunto e alta carga de trabalho; c) sistema de saúde: filas para atendimento médico, distância de unidades de saúde e centros de referência da moradia do paciente e experiênciasnegativas no serviço de saúde. É fundamental entender as possíveis causas de atraso e limitações dos serviços de saúde e de seus profissionais para que medidas adequadas sejam tomadas individual e coletivamente para propiciar diagnóstico e tratamento precoce aos pacientes.
In Brazil, hospital cancer records reveal the mouth as the eighth most frequent location of malignant tumors, most of them being diagnosed at advanced stages. In developed countries, diagnosis of late rates is about 40%. Early diagnosis and treatment represent increased chances of a cure, low cost, and less morbidity. This article aims to assess thepossible reasons for delays in the diagnosis and treatment of oral cancer and reflects on the reasons. The terms mouth neoplasias, diagnosis, epidemiology, and therapy were introduced in the MEDLINE, LILACS, and SciELO databases. A total of 31 studies published between 1995 and 2011 were analyzed, which discoursed about the delayed diagnosis in relation to patients, professionals, and healthcare systems. It was observedthat the diagnostic delay was associated with: a) patients: single, alcoholic, and afraid of the diagnosis; b) Professionals: little knowledge on the subject and high workload; c) healthcare systems: queues for medical care, distance between the patient?s residence and healthcare units and reference centers, and negative experiences in the healthcareservice. It is critical to understand the possible causes of delay and limitations of healthcare services and its professionals for appropriate actions to take place individually and collectively providing early diagnosis and treatment to these patients.