Prospective analysis of 231 elective neck dissections in oral squamous cell carcinoma with node negative neck-To decide the extent of neck dissection (original) (raw)
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International Journal of Head and Neck Surgery, 2014
Introduction Selective neck dissection (SND) is performed to prevent head and neck cancers metastasis. We tried to determine the incidence of level IIb lymph nodes metastasis and it is associations in head and neck cancers for selection of patients requiring SND. Materials and methods A retrospective study was conducted on 57 patients who underwent surgical removal of the head and neck tumor by 84 neck dissections. Fisher exact test was used to measure the association between positive IIb nodes and the other variables. Results Nine (15.8%) of 57 patients showed level IIb lymph nodes metastasis comprising 10.71% of the 84 neck dissections. Six (66.66%) were associated with oral cavity cancers, 8 (88.9%) with squamous cell carcinoma (SCC), 6 (66.66%) with T4 tumor. Five (55.6%) were N2b, and 7 (77.8%) were found in N+ necks. All (100%) positive IIb nodes were associated with metastatic level IIa. Significant associations were found betweenpositive IIbnodesand N2b (p= 0.005), clinicall...
Prospective study of 583 neck dissections in oral cancers: Implications for clinical practice
Head & Neck, 2014
Background. Determining the level of nodal metastases may help decrease the extent of neck dissections and reduce morbidity. Methods. A prospective study of neck dissections in patients with oral cancer was conducted. Each nodal level was delineated, sent for histopathology, and reported level-wise. Incidence of overall and isolated metastatic nodes at different levels was calculated. Logistic regression was used to find factors predicting metastases to levels IIB and V. Results. Five hundred eighty-three neck dissections were prospectively evaluated. A total of 95.7% metastases occurred at levels I to IV. Overall incidence of metastases to levels IIB and V was 3.8% and 3.3%, respectively. Multivariate analysis revealed IIA positivity as an independent predictive factor for metastases to both IIB and V. Conclusion. This study of lymph node mapping in patients with oral cancer showed a predictable pattern of lymph node metastasis according to primary site. Selective neck dissection (levels I-IV) in patients with oral cancers may be adequate. Determining status of level IIA is important to guide dissection of levels IIB and V. V
The Journal of Laryngology & Otology, 2014
Objectives:To determine the patterns of lymph node metastases in oral tongue carcinomas, and examine the implications for elective and therapeutic neck dissection.Method:The study entailed a retrospective analysis of 67 patients with previously untreated oral tongue squamous cell carcinoma who had undergone simultaneous glossectomy and neck dissection.Results:Of the 40 clinically node-negative patients, 7 patients had metastatic lymph nodes on pathological examination. No occult metastasis was found at level IV. Of the 27 clinically node-positive patients, the incidence rate of level IV metastasis was 11.1 per cent (3 out of 27 patients). No ‘skip metastases’ were found at level IV. Level IV metastases were significantly related to clinically staged nodes categorised as over 2a (p = 0.03) and metastasis to level III (p = 0.01).Conclusion:Routine inclusion of level IV in elective neck dissection is not necessary for clinically node-negative patients with oral tongue squamous cell car...
American Journal of Otolaryngology, 2012
Patients with surgically treated head and neck cancer and clinical N0 neck with high risk of occult lymph node metastasis undergo elective neck dissection (ND). Late lymph node metastasis may appear in those patients with pN0 neck. The aim of the present study was to analyze the incidence and clinical relevance of late lymph node metastasis in patients with head and neck cancer. Materials and Methods: The clinical data of 61 patients with head and neck cancer who had undergone elective ND with pN0 neck were retrospectively analyzed. Only patients without local failure, second primary, or radiochemotherapy were included in the study. Results: Late lymph node metastasis could be observed in 4 (6.5%) cases at the margin or outside the initially dissected lymph node levels. In those patients, the primary tumor was localized in the oral cavity (n = 3) or oropharynx (n = 1) and was classified in all cases as T1 or T2. Lymph node metastasis could be found in levels I (n = 2), II (n = 1), and IV (n = 1), respectively. Conclusion: Even in the case of pN0 neck after an elective ND, the appearance of late lymph node metastases must be expected. The low proportion of patients with late lymph node metastases after a selective ND in clinical and histologic N0 does not justify an extended form of neck surgery.
Head & Neck, 2008
Background. Selective neck dissection as a part of an elective or therapeutic treatment of the neck is a common practice during the surgical treatment of patients with head and neck cancer. Recently, the need for routine dissection of level IIb has been discussed. The aim of this study was to verify the incidence of metastases at level IIb in patients with clinically negative necks (N0) and clinically positive necks (N1) and discuss the need for its excision.
The role of neck dissection in cancer of the oral cavity
Carcinoma of the oral cavity is most often treated by surgical resection, is associated with clinically evident neck disease in one third of cases, and has a high rate of occult metastasis in the N 0 neck. When patients have clinically evident neck disease, comprehensive neck dissection is usually performed. Establishing an approach to the N 0 neck has been somewhat more difficult and controversial. The presence of occult neck metastasis carries both prognostic and therapeutic implications. The most reliable factor in determining the presence of metastasis is pathological evaluation; this is the rationale for performing staging neck dissections in patients with tumors of the oral cavity. Since two-thirds of these dissections will yield no tumor, the type of neck dissection should yield the most prognostic information while causing the least morbidity. A selective neck dissection encompassing Levels I-III satisfies these requirements well.
Analysis of the Role of Selective Neck Dissection in Clinically Node-Positive T3/T4 Oral Cancers
BioMed Research International
Introduction. The concept of selective neck dissection (SND) in locally advanced oral cancers is emerging. Contemporary studies support the feasibility of SND in selected node-positive oral cancers with early primaries. Nevertheless, the suitability of SND in clinically node-positive (cN+) oral cancers with advanced primaries (T3/T4) is unknown. Aim. This study explores if patients with cN+ advanced primaries were suitable candidates for SND by spotting the involved lymph node distribution in various stations of the neck. Secondary objectives were to check if predictive clinicopathological factors for metastases to the neck in general also apply for lymph node metastases to levels IV and V. Methods. The present retrospective study analysed the distribution of pathologically involved lymph nodes in 134 patients and explored the interrelation of various predictive factors and cervical metastases overall and those specific to levels IV and V. Results. Level V was involved in 6.7% (6/83...
Lymph nodes assessment of neck in oral squamous cell carcinoma and its implication in management
International Journal of Applied Dental Sciences, 2020
Background and Aim: This study was conducted to find the correlation between clinically palpable neck nodes and their histopathological examination results which gives some information to the clinician regarding the choice of treatment and for appropriate management of the neck. After the surgical procedure, the whole specimen was submitted for the histopathological examination and a correlation between clinical positive or negative nodes and their histologically confirmed malignancies were drawn. Materials & Methods: A total of 200 patients with the diagnosis of oral malignancy subjected to oral and maxillofacial surgery department and institute of oncology over the period of 2 years were included in the study. Once the confirmation by histopathology was done, routine blood investigation, HIV/HBSAg test, ECG was done and physician's consent was taken prior to surgery under general anaesthesia. Pre-operatively thorough clinical palpation of the five levels of cervical lymph nodes was performed bilaterally. Results: On clinical examination of lymph nodes by palpation in 200 cases, 50 sides of necks were negative for palpation and 162 sides of necks were positive for palpation. On the histopathological examination of neck dissections, 8 of necks were positive. That is 46 cases were true positive that the histopathology showed no metastasis and 8 cases were false positive which showed metastasis in histopathology. Conclusion: Histopathology examination with its ability to detect 100% metastases in cervical lymph nodes remains the gold standard. Even though, Clinical examination was and is still the routine first line in detecting cervical lymph node metastases in head and neck squamous cell carcinoma, Its use shall be restricted for only an initial evaluation of the patient.
Neck dissection for oral squamous cell carcinoma: our experience and a review of the literature
Journal of the Korean Association of Oral and Maxillofacial Surgeons, 2015
This article describes our experience with neck dissection in 10 patients with oral squamous cell carcinoma. 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. 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-region...