The effectiveness of elective neck dissection on early (stage I, II) squamous cell carcinoma of the oral tongue

OBJECTIVES: The purpose of this study was to evaluate and compare the treatment outcomes of partial glossectomy with or without elective neck dissection in patients with tongue squamous cell carcinoma (SCCa). MATERIALS AND METHODS: A total of 98 patients who were diagnosed with tongue SCCa and underwent partial glossectomy between 2005 and 2014 were evaluated. Only 14 patients received elective neck dissection, and 84 patients received only partial glossectomy. RESULTS: There were 56 men and 42 women with a mean age of 57 years and mean follow-up period of 33.7 months. There were 70 patients graded as T1 and 28 as T2. The total occult metastasis rate was 17.3%. The 5-year overall survival rate was 83.3% with elective neck dissection and 92.4% with observation. The 5-year disease-free survival rate was in 70.7% in the elective neck dissection group and 65.3% in the observation group. CONCLUSION: We retrospectively reviewed the records of 98 patients with tongue SCCa. These patients were divided into two groups, those who underwent elective neck dissection and those who did not. There was no statistically significant difference between the groups undergoing partial glossectomy with or without elective neck dissection.

Clinical Value of Blood Neutrophil to Lymphocyte Ratio in Patients with Papillary Thyroid Carcinoma with Neck Lymph Node Metastasis

BACKGROUND AND OBJECTIVES: Blood neutrophil-to-lymphocyte ratio (NLR) has been reported to have poor prognostic impact in variable malignancies. However, studies evaluating the clinical significance of blood NLR in patient with papillary thyroid carcinoma (PTC) has been relatively rare, and the outcomes were inconsistent. In this study, we sought to analyze the clinical value of NLR in patients with PTC who had cervical lymph node metastasis. MATERIALS AND METHODS: Retrospective chart review was conducted with 174 patients with confirmed neck metastasis of PTC after initial thyroidectomy. Blood NLR was estimated by dividing the absolute number of blood neutrophil with that of lymphocyte. Statistical analysis was conducted to evaluate correlation between NLR and clinicopathologic factors, patterns of metastatic lymph nodes, and recurrence. RESULTS: Higher NLR (>1.74) was correlated to younger age of patients ( < 45 years, p=0.045) and smaller size of tumor ( < 1 cm, p=0.017). Blood NLR had no impact on patterns of lymph node metastasis or recurrence. CONCLUSION: Blood NLR may not be considered as a predictive factor for clinical aggressiveness or prognosis in patients with PTC with lymph node metastasis.

Surgical Outcomes of Robotic MRND versus Conventional Open MRND for Papillary Thyroid Carcinoma with Lateral Neck Node Metastasis: Comparative Analysis using Propensity Score Matching / 대한내분비외과학회지

PURPOSE: During the past decade, various endoscopic thyroid surgeries have been conducted, each with its own benefits. The incorporation of robotic systems to endoscopic thyroid surgery has improved the visualization and precision of endoscopic techniques. We previously reported our initial experience with robotic modified radical neck dissection (MRND) of papillary thyroid carcinoma (PTC) with lateral neck node metastasis (LNM). The aim of this study was to compare surgical outcomes of robotic vs. conventional open MRND of PTC with LNM using propensity score matching. METHODS: From January 2008 to February 2011, 515 patients with PTC with LNM were enrolled. One hundred patients underwent robotic MRND, and 415 patients underwent conventional open MRND. These two groups were retrospectively compared with respect to their clinicopathological characteristics, surgical outcomes, and surgical completeness. Furthermore, to avoid selection bias, propensity score matching analysis was used to compare surgical outcomes of each group without any compounding factors. RESULTS: The operative time for the robotic MRND was longer than for the open MRND (297.9±60.2 min vs. 212.1±55.6 min, P=0.089). However, the mean numbers of retrieved lymph nodes and mean hospital stay after surgery were similar in the two groups (36.0±12.9 vs. 40.8±13.3, P=0.235), (6.1±1.6 days vs. 6.1±2.1 days, P=0.577). The complication rates were similar between the two groups, and there was no statistical difference in postoperative thyroglobulin levels between groups (0.51±0.83 ng/ml vs. 0.89±2.46 ng/ml, P=0.593). CONCLUSION: According to our study, robotic MRND shows similar surgical outcomes to conventional open MRND after case-matched analyses. We suggest that robotic MRND is an acceptable alternative as an operative method for PTC with LNM, resulting in excellent cosmesis and patient satisfaction.

Lymph nodes metastases in central compartment of laryngeal cancer:A 11-year review of surgical ;treatment cases / 中国癌症杂志

Background and purpose: The aim of this study was to determine the necessity of central compartment neck dissection in laryngeal cancer.Study Design: Retrospective study at a tertiary referral medical center. Methods:Patients with laryngeal squamous cell cancer who underwent neck dissection were evaluated, and a retrospective analysis of clinicopathologic factors and follow-up data were performed. Results: One hundred and eighteen patients from 1999 to 2009 were enrolled. There were 11.9% central compartment lymph node metastasis in all patients, including the 10 patients with central compartment lymph node metastasis in 34 patients underwent compartment neck dissection and 4 patients do not underwent compartment neck dissection but had central neck recurrence in the follow up time. Subglottic or pyriform extension were risk factors in central compartment lymph node metastasis and central neck recurrence (P=0.002). Central compartment lymph node metastasis had closed relationship with levelⅣmetastasis (P<0.001), extracapsular extension (P=0.001), vascular extension (P=0.015) and poor local control rates (P=0.035) respectively. Patients who were positive for lateral neck lymph node metastasis had poor disease-free survival rate (P=0.014) and poor local control rates (P=0.025), and supraglottic cancer had a trend to metastases to levelⅡ(P=0.044). Conclusion:Central compartment neck dissection might be considered a potential therapeutic approach for patients with laryngeal cancer.

Diagnostic accuracy of 18F-FDG in nodal negative oral squamous cell carcinoma

PET is one of the most widely used verification methods for evaluation of metastasis on the lymph nodes of the neck in oral cancer patients. The purpose of this study was to assess the correlation between PET findings and histopathologic findings in patients who had been diagnosed as squamous cell carcinoma and performed neck dissection. Thirty-four necks in 25 patients had been evaluated on pathologic lymph nodes and the data were compared with preoperative PET scan. The sensitivity of PET at the level of the neck was 72.7percent, specificity was 60percent, and accuracy was 79.2percent. Since FDG-PET show high false-positive results, it should be used with other diagnostic tools for evaluation of lymph node metastasis.

Necessity of Prophylactic Central Lymphadenectomy in the Treatment of Thyroid Papillary Carcinoma: A Preliminary Report / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Papillary thyroid carcinoma (PTC) tends to have highly metastatic property, especially in the central compartment, and central lymphadenectomy (CL) in patients with PTC is still controversial. This study determines the necessity of prophylactic central lymphadenectomy with total thyroidectomy in patients with PTC based on metastatic probability of tumors and lymph nodes, and surgical morbidity following CL. SUBJECTS AND METHOD: Extracapsular spread, endolymphatic tumor emboli, and the location of metastatic lymph nodes in the central compartment were analyzed according to pertinent pathological methods. The complications following CL were compared between CL and control groups. RESULTS: A total of 43 patients with PTC underwent CL. Forty of them (95%) presented extracapsular spread of the primary tumor and 42 patients (98%) presented tumor emboli in lymphovascular space of tumors. Twenty-nine patients (67%) had lymph node metastasis in the central compartment. No statistical correlation between tumor size or location of primary tumor and subsites of the metastatic lymph nodes was found. The complication rates of vocal cord paralysis or hypocalcemia showed no statistical difference between groups. Seven patients with previous history of total thyroidectomy underwent central lymphadenectomy for recurred PTC and one hypocalcemia and two vocal cord paralysis were encountered, respectively. CONCLUSION: Our results suggest that high nodal metastases rates of PTC into the central compartment and no significant increase of postoperative morbidity can justify CL combined with total thyroidectomy in patients with PTC.

Metastatic Cervical Lymphadenopathy from Uterine Leiomyosarcoma with Good Local Response to Radiotherapy and Chemotherapy / 대한방사선종양학회지

The metastasis of uterine leiomyosarcoma to the neck node has not been reported previously and the radiotherapy has been rarely used for the metastatic lesion of the other sites. We report a case of neck metastasis from a uterine leiomyosarcoma, which developed 10 months after surgery and postoperative pelvic radiotherapy. It also involved the parapharyngeal space, adjacent spine, and spinal canal. The metastatic neck mass was inoperable, and was treated by neck radiotherapy (6,000 cGy) and chemotherapy including taxol and carboplatin. The mass has regressed progressively to a nearly impalpable state. She has never developed spinal cord compression syndrome, and has maintained good swallowing for eight months since the neck radiotherapy and chemotherapy. Since the extensive metastatic neck mass showed good local response to high dose radiotherapy and chemotherapy, both treatments may be considered for an unresectable metastatic leiomyosarcoma.

Experience of the Elective Neck Dissection in Clinical N0 Neck / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The status of cervical lymph node is a great influence to the prognosis of patient with head and neck cancer. There has been a great controversies on the treatment of clinical N0 neck. The purpose of this study is to analyze the outcomes of the elective neck dissection in clinical N0 neck of various sites of primary lesion. MATERIALS AND METHODS: The authors analyzed the outcomes of elective neck dissection by retrospective study with review of records of 38 head and neck cancer patients (56 sites) who had clinically N0 neck. RESULTS: The overall rate of occult neck metastasis was 31.6%. Occult neck metastasis rates according to primary sites were 37.5% (supraglottic larynx), 25.0% (glottis), 25.0% (hypopharynx) and 20. 0% (tongue) and according to T stage were 50,0% (T1), 13.3% (T2), 57.1% (T3) and 0% (T4). Four cases had nodal recurrence (1 out of 4 had occult neck metastasis) after elective neck dissections and there were no significant postoperative complications. CONCLUSION: Due to relatively high overall occult neck metastasis rate, and no significant postoperative complications, the elective neck dissection should be considered against potential possibility of occult neck metastasis in the primary sites and extent of head and neck cancers.

Occult Neck Metastasis in Larynx and Hypopharynx Squamous Cell Carcinomas Confirmed with Simultaneous Bilateral Elective Neck Dissection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Neck metastasis is one of the most important prognostic factor in treating head and neck squamous cell carcinomas. Recently, elective neck dissection has been widely accepted for accurate pathologic staging and elective treatment of neck. Occult metastasis rate of laryngeal and hypopharyngeal cancer varies widely depending upon authors. However, occult metastasis rate confirmed with simultaneous bilateral elective dissection is rare. MATERIALS AND METHODS: Fifty patients (100 necks) who underwent surgery for laryngeal and hypopharyngeal squamous cell carcinomas as an initial treatment from 1992 to 1997 were evaluated. All had bilateral elective neck dissection at the time of surgery for the primary treatment. Charts and pathologic reports were reviewed. RESULT: Occult neck metastasis rate by primary site were as follows. Supraglottis ipsilateral 40% (8/20) contralateral 15% (3/20), glottis ipsilateral 18% (4/22), contralateral 0% (0/22), hypopharynx ipsilateral 88% (7/8), contralateral 25% (2/8). CONCLUSION: Supraglottic and hypopharyngeal cancer may need elective neck treatment bilaterally. Contralateral neck occult metastasis from glottic cancer was minimal.