Elective Neck Dissection for Primary Oral Cavity Squamous Cell Carcinoma Involving the Tongue Should Include Sublevel IIb

Early stage oral cavity squamous cell carcinoma (OCSCC) has a significant risk of subclinical nodal metastases, which is the strongest independent prognostic factor for regional recurrence and survival. However current preoperative imaging modalities are unable to identify patients with micrometastases, and an observation strategy has been associated with inferior outcomes when compared to an elective neck dissection. Sentinel lymph node biopsy provides a safe and accurate staging procedure to select the patients who benefit from an elective neck dissection, while avoiding unnecessary surgery in the patients who are node negative. There is recent Level II evidence demonstrating equivalent oncological outcomes when compared with elective neck dissection. However, a multidisciplinary approach is required including reliable mapping of the sentinel lymph node, precise surgical technique and comprehensive histopathological analysis to ensure accurate results are obtained.

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Elective Neck Dissection Versus Wait-and-Watch Policy for Oral Cavity Squamous Cell Carcinoma in Early Stage: A Systematic Review and Meta-Analysis Based on Survival Data

Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.joms.2019.03.015 ◽

2019 ◽

Vol 77 (10) ◽

pp. 2154-2167 ◽

Cited By ~ 9

Author(s):

Yubin Cao ◽

Tao Wang ◽

Changhao Yu ◽

Xia Guo ◽

Chunjie Li ◽

...

Keyword(s):

Systematic Review ◽

Squamous Cell Carcinoma ◽

Oral Cavity ◽

Cell Carcinoma ◽

Neck Dissection ◽

Squamous Cell ◽

Survival Data ◽

Early Stage ◽

Meta Analysis ◽

Elective Neck Dissection

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Detection of Cervical Lymph Node Micrometastases in Patients with Squamous Cell Carcinoma of the Oral Cavity, Pharynx and Larynx

Acta Medica (Hradec Kralove Czech Republic) ◽

10.14712/18059694.2015.95 ◽

2015 ◽

Vol 58 (2) ◽

pp. 62-65 ◽

Cited By ~ 1

Author(s):

Petr Čelakovský ◽

David Kalfeřt ◽

Katarína Smatanová ◽

Viktor Chrobok ◽

Jan Laco

Keyword(s):

Squamous Cell Carcinoma ◽

Oral Cavity ◽

Lymph Nodes ◽

Cell Carcinoma ◽

Neck Dissection ◽

Tumor Cells ◽

Squamous Cell ◽

Elective Neck Dissection ◽

Cervical Lymph Nodes ◽

Level I

Background: The goal of this prospective study was to determine the frequency of micrometastases in patients with squamous cell carcinoma (SCC) of the oral cavity, pharynx and larynx in whom elective neck dissection was indicated (cN0). Patients and Methods: A total of 12 patients (10 males and 2 females) were enrolled in the study. The age ranged 42–73 years (median 62 years). Elective neck dissection was performed in all patients (8 ipsilateral, 4 bilateral) and a total of 256 lymph nodes were removed and sent for microscopic examination. Results: The presence of tumor cells in cervical lymph nodes was found in 5/12 (42%) patients. Micrometastases of SCC were found in two patients and isolated tumor cells (ITC) in two other patients. In the remaining one patient with oropharyngeal SCC, a micrometastasis of papillary thyroid carcinoma (PTC) was detected. Positive lymph nodes were localized in level II in three patients with SCC of larynx, hypopharynx and tongue base, respectively, in level I in one patient with SCC of oral tongue and in level III in one patient with PTC. Conclusion: Our results indicate that SCC of head and neck has a high potential for creating micrometastases which frequency is higher compared to clinically detected macrometastases. Therefore, elective neck dissection or radiotherapy of the neck should be considered in patients with high risk of occult metastases or micrometastases.

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Radical Neck Dissection Versus Conservative Neck Dissection for Squamous Cell Carcinoma of the Oral Cavity

Carcinoma of the Oral Cavity and Oropharynx - Recent Results in Cancer Research ◽

10.1007/978-3-642-84971-8_7 ◽

1994 ◽

pp. 57-62 ◽

Cited By ~ 5

Author(s):

J. Bier

Keyword(s):

Squamous Cell Carcinoma ◽

Oral Cavity ◽

Cell Carcinoma ◽

Neck Dissection ◽

Squamous Cell ◽

Radical Neck Dissection

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Elective neck dissection for the node-negative neck during salvage laryngectomy: an analysis of survival outcomes and complication rates

The Journal of Laryngology & Otology ◽

10.1017/s0022215119001725 ◽

2019 ◽

Vol 133 (09) ◽

pp. 788-791

Author(s):

M Gouzos ◽

O Dale ◽

N Sethi ◽

A Foreman ◽

S Krishnan ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Neck Dissection ◽

Squamous Cell ◽

Elective Neck Dissection ◽

Survival Outcomes ◽

Pharyngocutaneous Fistula ◽

Complication Rates ◽

True Value ◽

Salvage Laryngectomy

AbstractObjectivesThis study aimed to evaluate the effect of neck dissection on survival and complication rates in patients with no clinical or radiological evidence of cervical nodal disease (N0) undergoing salvage laryngectomy.MethodsA retrospective study was conducted of patients with squamous cell carcinoma of the larynx following primary radiotherapy that required salvage laryngectomy. Disease-free and overall survival rates were compared over three years using Kaplan–Meier analysis. Pharyngocutaneous fistula rate, hospitalisation length and the requirement for further surgical intervention were also compared across cohorts.ResultsTwenty-three cases met the inclusion criteria (17 neck dissections, 6 undissected). No significant differences in survival outcomes were identified. One patient who underwent neck dissection for advanced, recurrent transglottic squamous cell carcinoma showed evidence of occult lymph node metastases. Fistula rates did not differ significantly between dissected and non-dissected groups; however, two patients required surgical repair of post-operative pharyngocutaneous fistula following neck dissection.ConclusionIn this study, elective neck dissection did not appear to alter survival outcomes or complication rates during salvage laryngectomy. Given the small but significant risk of occult neck metastases, its true value remains unclear.

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