Is Selective Neck Dissection Adequate Treatment for Node-Positive Disease?

Aim. To share experience with regional failures after selective neck dissection in both node negative and positive previously untreated patients diagnosed with squamous cell carcinoma of the oral cavity.Patients and Methods. Data of 219 patients who underwent SND at Shaukat Khanum Cancer Hospital from 2003 to 2010 were retrospectively reviewed. Patient characteristics, treatment modalities, and regional failures were assessed. Expected 5-year regional control was calculated and prognostic factors were determined.Results. Median follow-up was 29 (9–109) months. Common sites were anterior tongue in 159 and buccal mucosa in 22 patients. Pathological nodal stage was N0 in 114, N1 in 32, N2b in 67, and N2c in 5 patients. Fourteen (6%) patients failed in clinically node negative neck while 8 (4%) failed in clinically node positive patients. Out of 22 total regional failures, primary tumor origin was from tongue in 16 (73%) patients. Expected 5-year regional control was 95% and 81% for N0 and N+ disease, respectively (P<0.0001). Only 13% patients with well differentiated, T1 tumors in cN0 neck were pathologically node positive.Conclusions. Selective neck dissection yields acceptable results for regional management of oral squamous cell carcinoma. Wait and see policy may be effective in a selected subgroup of patients.

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Selective Neck Dissection and Survival in Pathologically Node-Positive Oral Squamous Cell Carcinoma

Cancers ◽

10.3390/cancers11020269 ◽

2019 ◽

Vol 11 (2) ◽

pp. 269 ◽

Cited By ~ 1

Author(s):

Shunichi Shimura ◽

Kazuhiro Ogi ◽

Akihiro Miyazaki ◽

Shota Shimizu ◽

Takeshi Kaneko ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Oral Squamous Cell Carcinoma ◽

Lymph Nodes ◽

Cell Carcinoma ◽

Neck Dissection ◽

Squamous Cell ◽

Radical Neck Dissection ◽

Selective Neck Dissection ◽

Neck Node ◽

Node Positive

The most important prognostic factor in oral squamous cell carcinoma (OSCC) is neck metastasis, which is treated by neck dissection. Although selective neck dissection (SND) is a useful tool for clinically node-negative OSCC, its efficacy for neck node-positive OSCC has not been established. Sixty-eight OSCC patients with pN1–3 disease who were treated with curative surgery using SND and/or modified-radical/radical neck dissection (MRND/RND) were retrospectively reviewed. The neck control rate was 94% for pN1–3 patients who underwent SND. The five-year overall survival (OS) and disease-specific survival (DSS) in pN1-3 OSCC patients were 62% and 71%, respectively. The multivariate analysis of clinical and pathological variables identified the number of positive nodes as an independent predictor of SND outcome (OS, hazard ratio (HR) = 4.98, 95% confidence interval (CI): 1.48–16.72, p < 0.01; DSS, HR = 6.44, 95% CI: 1.76–23.50, p < 0.01). The results of this retrospective study showed that only SND for neck node-positive OSCC was appropriate for those with up to 2 lymph nodes that had a largest diameter ≤3 cm without extranodal extension (ENE) of the neck and adjuvant radiotherapy. However, the availability of postoperative therapeutic options for high-risk OSCC, including ENE and/or multiple positive lymph nodes, needs to be further investigated.

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Management of the node positive neck in oral squamous cell carcinoma by selective neck dissection: 114 patients with 5 years follow up

British Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.bjoms.2011.03.102 ◽

2011 ◽

Vol 49 ◽

pp. S59-S60

Author(s):

M.L. Goodson ◽

R.J. Banks ◽

I.C. Martin

Keyword(s):

Squamous Cell Carcinoma ◽

Oral Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Neck Dissection ◽

Squamous Cell ◽

Selective Neck Dissection ◽

Node Positive

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Therapeutic selective neck dissection (level II–V) for node-positive hypopharyngeal carcinoma: is it oncologically safe?

Acta Oto-Laryngologica ◽

10.1080/00016480802001483 ◽

2009 ◽

Vol 129 (1) ◽

pp. 57-61 ◽

Cited By ~ 6

Author(s):

Young Chang Lim ◽

Jin Seok Lee ◽

Eun Chang Choi

Keyword(s):

Neck Dissection ◽

Hypopharyngeal Carcinoma ◽

Selective Neck Dissection ◽

Node Positive ◽

Level Ii

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Is routine neck dissection warranted at salvage laryngectomy?

The Journal of Laryngology & Otology ◽

10.1017/s0022215121001808 ◽

2021 ◽

pp. 1-6

Author(s):

S Sharma ◽

D A Chaukar ◽

M Bal ◽

A K D'Cruz

Keyword(s):

Neck Dissection ◽

Residual Disease ◽

Multivariable Analysis ◽

Nodal Metastasis ◽

Elective Neck Dissection ◽

Occult Metastasis ◽

Initial Node ◽

Node Positive ◽

Node Positive Disease ◽

Salvage Laryngectomy

Abstract Background There is controversy regarding management of the neck at salvage laryngectomy. The aim of this study was to perform an analysis to determine the incidence of occult node positivity in this group and analyse factors affecting it. Method A retrospective analysis of 171 patients who underwent salvage total laryngectomy between 2000 and 2015 for recurrent or residual disease following definitive non-surgical treatment and were clinico-radiologically node negative at the time salvage laryngectomy was carried out. Results A total of 171 patients with laryngeal or hypopharyngeal cancers underwent concurrent neck dissection at laryngectomy. There were 162 patients (94.7 per cent) who underwent bilateral neck dissection, and 9 patients (5.3 per cent) who underwent ipsilateral neck dissection. The occult lateral nodal metastasis rate was 10.5 per cent. Of various factors, initial node positive disease was the only factor predicting occult metastasis on univariable and multivariable analysis (p = 0.001). Conclusion Risk of occult metastasis is high in patients who have node positive disease before starting radiotherapy. This group should be offered elective neck dissection.

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