S174 – Therapeutic Selective Neck Dissection Outcomes

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P134-P134
Author(s):  
Peter M Shepard ◽  
Olson Jordan ◽  
Glen E Leverson ◽  
Paul M Harari ◽  
Gregory K Hartig
Keyword(s):  
Neck Dissection ◽  
Primary Tumor ◽  
Postoperative Radiotherapy ◽  
Radical Neck Dissection ◽  
Retrospective Chart Review ◽  
Regional Recurrence ◽  
Selective Neck Dissection ◽  
Nodal Metastases ◽  
Neck Node ◽  
Primary Tumor Site

Objectives To examine the efficacy of selective neck dissection in patients with nodal metastases from head and neck squamous cell carcinoma. Methods A retrospective chart review was performed on a cohort of 156 subjects with clinically positive regional nodal metastases, whose initial management included neck dissection by a single surgeon from 1994–2007. 69 subjects underwent selective neck dissection (SND), while 87 underwent radical or modified radical neck dissection (R/MRND). The majority of subjects (81%) received postoperative radiotherapy. Primary outcomes included 3-year regional recurrence and 5-year overall survival, using Kaplan-Meier analysis. Results Following exclusion of subjects with local recurrence before or concurrent with regional recurrence, there were 4 (8.6%) regional recurrences in the SND group and 15 (22%) in the R/MRND group. 2 and 6 of these recurrences involved the contralateral neck in each group, respectively. Using multivariate analysis we adjusted for differences in nodal and primary tumor stage, primary tumor site, year of surgery, extracapsular spread, and postoperative radiotherapy rates. The lower regional recurrence rate in the SND group remained statistically significant (p=0.02). Overall 5-year survival was 46% in the SND group vs. 34% in the R/MRND group (p=0.23). Conclusions These results demonstrate excellent regional disease control following SND in patients with neck node metastases. SND with adjunctive radiotherapy remains our preferred approach for most patients undergoing therapeutic neck dissection.

scholarly journals The Extent of Neck Dissection Among Patients Who Receive Adjuvant Radiotherapy for HNSCC and Its Effect on Disease-Specific and Overall Survival

2019 ◽  
Vol 98 (4) ◽  
pp. 227-231
Author(s):  
Usama M. Aboelkheir ◽  
Austin J. Iovoli ◽  
Alexis J. Platek ◽  
Chong Wang ◽  
Gregory M. Hermann ◽  
...  
Keyword(s):  
Overall Survival ◽  
Neck Dissection ◽  
Primary Tumor ◽  
Adjuvant Radiotherapy ◽  
Regional Recurrence ◽  
Comprehensive Cancer Center ◽  
Selective Neck Dissection ◽  
Cervical Lymph Nodes ◽  
Study Objective ◽  
Disease Specific

The study objective was to assess if the extent of neck dissection among patients who receive adjuvant radiotherapy affects regional recurrence and survival. This was a retrospective study of patients who had clinical metastatic mucosal primary squamous cell carcinoma (SCC) to cervical lymph nodes done at Roswell Park Comprehensive Cancer Center, Buffalo, New York from 2004 to 2015. Patients with previous radiotherapy and/or chemotherapy were excluded. All patients had surgery to the primary tumor and the neck followed by adjuvant (chemo) radiation. Patients have been divided into 2 groups according to type of neck dissection as either selective neck dissection (SND) or comprehensive neck dissection (CND). The extent of neck dissection was determined by surgeon preference. All patients received postoperative radiotherapy to the primary tumor bed and to the neck with or without chemotherapy. Main outcomes were measured in regional recurrence and overall survival. In our study, 74 patients were included. Among the 2 groups of patients, 3-year outcomes for regional recurrence occurred in 4 (7.1%) of 56 patients in the SND group and 2 (11.1%) of 18 patients in the CND group. Overall survival was 29 (51.8%) of 56 patients in the SND group and 11 (61.1%) of 18 patients in the CND group ( P = .497). Among patients who died in each cohort, disease-specific death was 20 (74.1%) of 27 patients in the SND group and 5 (71.4%) of 7 patients in the CND group ( P = .79).The overall and disease-specific survival differences between the SND and CND cohorts were not statistically significant. In conclusion, SND, combined with proper adjuvant treatment, achieved regional control and survival rates comparable to CND.

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

Cancers ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. 269 ◽  
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.

scholarly journals Jugular neck dissection for NO neck supraglottic carcinoma

2004 ◽  
Vol 132 (3-4) ◽  
pp. 73-75 ◽  
Author(s):  
Zeljko Petrovic ◽  
Svetislav Jelic ◽  
Ivica Pendjer
Keyword(s):  
Neck Dissection ◽  
Histological Examination ◽  
Primary Tumor ◽  
Postoperative Radiotherapy ◽  
Selective Neck Dissection ◽  
Occult Metastases ◽  
Cervical Metastases ◽  
Local Spread ◽  
Level Ii ◽  
Negative Findings

Appropriate management of patients with supraglottic laryngeal carcinoma and negative findings in the neck is still controversial. A prospective and retrospective study comprised 193 patients who were treated primary surgically between 1976 and 1993. They all had clinically and ultrasound negative findings on the neck (NO). Supraglottic carcinomas usually spread regionally. Metastases develop in the jugular group, between level II-IV. The incidence of metastases has been reported to vary from 12 to 62.5%. The size and localization of the primary tumor, its histological grade, genotype of the malignant cells, imunological and other elucidated factors can all affect the incidence of regional spread. AIM Aim of this study was to specify the incidence of occult cervical metastases; to analyze the distribution of occult metastases related to tumor localization; to specify the distribution of occult metastases related to local spread; to analyze the distribution of occult metastases according to localization in the neck. RESULTS All patients had primary surgery of primary tumor and bilateral jugular, selective neck dissection at the level II-IV with histological examination of removed lymphoid tissue. Out of 193 patients, metastatic deposits were detected in 35(18%). Occult metastases were found in patients with carcinoma of the epilarynx in 19% (14/72) of cases, and in 17% (21/121) patients with carcinoma of the supraglottis excluding the epilarynx. This difference in frequency is not statistically significant. The incidence of occult metastases in epilaryngeal tumors did not depend on the degree of local spread. Even relatively small tumors (T1 and T2) yielded occult metastases in 33% (5/15), and 24% (6/25) of patients, respectively. In patients with T1 tumors localized at the supraglottis, excluding the epilarinx, occult metastases were not found. In the supragiottis excluding the epilarynx increased local spread was associated an increase of occult metastases. The incidence of occult metastases was directly related to the degree of the local spread of the tumor in the supraglottis excluding the epilarynx (Table 1). Occult metastases were usually ipsilateral, like the palpable ones. In medially localized tumors bilateral netastases were possible. Ipsilateral metastases were more frequent than both bilateral and contralateral ones. The possibility of contraiateral and bilateral occult metastases necessitated bilateral neck dissection. Postoperative radiotherapy (60 Gy) was given to all patients with verified occult metastases. Only in two patients (1%) of the total did metastases develop subsequently, indicating the effectiveness of planned postoperatrive radiotherapy. DISCUSSION Controversies in application of jugular, selective neck dissection are presently since it has been in use, because of the unclear role wich regional lymph tissue play in antitumor immune response. Jugular, selective neck dissection was advocated in all patients with a primary supraglottic laryngeal carcinomas. It was suggested that selective neck dissection was needed only in advanced (T3 and T4) tumors. Selective dissection is believed to be needed only when tumor has spread into the vallecula, the base of the tongue, or the medial wall of the piriform sinus. The idea of selective neck dissection has been opposed since the protective role of the cervical lymph tissue has been stressed. Ultrasound and computerized tomography of the neck cannot detect occult metastases. Today, only removal and histological examination of the lymph tissue can determine occult metastasis. The importance of selective neck dissection is considered in diagnostic biopsy procedure by wich occult metastatic spread in the neck region is established. CONCLUSION Due to the tendency of supraglottic carcinoma resulting in occult cervical metastases, early detection is imperative in order to apply the appropriate therapy. Occult cervical metastases are usually ipsilateral, but bilateral and contralateral may be found as well. Due to the aforementioned, it is necessary to perform bilateral jugular, selective cervical dissection of the neck level II-IV with histological evidence of removed lymph tissue. When metastases is verified histologically, postoperative radiotherapy is indicated as being efficent in hampering the development of palpable metastases. Five-year survival with no evidence disease is 86% (166/193).

scholarly journals A case series of metastatic lateral cervical lymphadenopathy

2017 ◽  
Vol 4 (3) ◽  
pp. 988
Author(s):  
Amit Narayan Pothare ◽  
Karuna Ilamkar
Keyword(s):  
Head And Neck ◽  
Neck Dissection ◽  
Primary Tumor ◽  
Radical Neck Dissection ◽  
Case Series ◽  
Cervical Lymphadenopathy ◽  
Neck Region ◽  
Signs And Symptoms ◽  
Selective Neck Dissection ◽  
Occult Metastasis

Background: Metastasis is a common cause of lymphadenopathy, seen mainly in patients above 40 years of age. Regional nodes entrap the tumor cells and setup complex immunological reactions within the nodes. The histological appearance of the nodes often suggests the primary tumor. The head and neck cancers spread to regional nodes via embolism and permeation. Primary site is evident most of times. The nodes are initially mobile but later may becomes fixed. The aim was to study the lateral cervical metastasis secondary to either lymphatic spread from distant primary or occult metastasis, their signs and symptoms, diagnostic procedure and treatment modalities.Methods: The study was conducted from July 2012 to June 2015. All patients having cervical lymphadenopathy secondary to metastasis diagnosed by FNAC, are included in study. Patients are evaluated as a whole, starting with clinical history and examinations as per proforma. In cases of lympahdenopathy where the diagnosis was not established with FNAC, biopsy was performed and efficacy of FNAC has been calculated. Results: Total 37 patients are studied. Most cases occurred in 5th decade of life, followed by 4th decade. More common in male 83.70% as compared to female 16.30% due to tobacco and smoking addiction more common in males. Change in voice is most common presentation in 46% of cases, followed by dysphagia in 35.13% of patients. Primary tumor was evident in 83.78% of cases and occult in 16.22%. Fixed nodes present in 54.05%, reduced mobility in 21.62% and mobile in 24.32%. FNAC was done in all the cases and positive results obtained in 91.8% with sensitivity of 90% and specificity of 98%. In patients treated by neoadjuvant chemotherapy followed by modified neck dissection, no recurrence occurred. Out of 10 patients treated by radical neck dissection only 2 patients had recurrence in follow up period and managed by radiotherapy. In 15 patients treated by radical radiotherapy, 5 patients had local recurrence and required selective neck dissection in follow up.Conclusions: Cervical lymph node metastasis was major presentation of malignancies of head and neck region and also from distant site. Whenever presents, it should raise suspicion of metastatic origin. Early diagnosis of primary tumor followed by aggressive treatment via multimodal approach prolongs survival.

Recurrence of laryngeal or hypopharyngeal primary tumor after radical neck dissection for postradiotherapy neck nodal metastases

Head & Neck ◽  
1994 ◽  
Vol 16 (6) ◽  
pp. 555-558 ◽  
Author(s):  
Chiu M. Ho ◽  
Kam H. Lam ◽  
William I. Wei ◽  
Lai K. Lam ◽  
Po W. Yuen
Keyword(s):  
Neck Dissection ◽  
Primary Tumor ◽  
Radical Neck Dissection ◽  
Nodal Metastases

scholarly journals Results of supraglottic partial horizontal laryngectomies

2003 ◽  
Vol 56 (11-12) ◽  
pp. 568-570
Author(s):  
Zeljko Petrovic
Keyword(s):  
Neck Dissection ◽  
Postoperative Radiotherapy ◽  
Radical Neck Dissection ◽  
Disease Free Survival ◽  
Functional Results ◽  
Selective Neck Dissection ◽  
Simultaneous Treatment ◽  
Supraglottic Laryngectomy ◽  
Laryngeal Surgery ◽  
Primary Surgery

Introduction Supraglottis is a part of larynx comprising two sub regions: epilarynx (suprahyoid epiglottis - including lingual and laryngeal surface, aryepiglottic folds - laryngeal surface, and arytenoids) and supraglottis without epilarynx (infrahyioid epiglottis and ventricular folds). Material and methods A total of 234 patients with supraglottic squamous cell carcinoma undergoing primary surgery were analyzed in the period 1976-1996. The tumor was localized in epilarynx in 84 (25%) patients, and in supraglottis without epilarynx in 261 (75%) cases. Results T1 tumor was present in 145 (42%) patients, T2 tumor was found in 178 (52%) patients, while T3 was reported in 22 (6%) cases. Clinically negative neck (N0) was found in 290 (84%) patients, and palpable metastases (N1) manifested in 55 (16%) cases. Local recurrences were established in 18 (5%) patients, and subsequent postoperative cervical metastases were found in 45 (13%) cases. Five-year disease-free survival was reported in all patients approximately 12 days following surgery. 27 patients developed laryngeal stenosis and only 2 patients were not decanulated. Voice and speech functions were satisfactory. Discussion Supraglottic laryngectomy, extended supraglottic laryngectomy is fully justified from oncological and functional aspects. Selective neck dissection in N0 cervical findings provides detection of occult metastases and indicates need for postoperative radiotherapy. Conclusion Oncological and functional results of supraglottic laryngeal surgery, along with simultaneous treatment of neck by selective, modified radical neck dissection and postoperative radiotherapy offer hope for treatment of supraglottic laryngeal cancer.

scholarly journals The importance of flaps in reconstruction of locoregionally advanced lateral skull-base cancer defects: a tertiary otorhinolaryngology referral centre experience

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Domen Vozel ◽  
Peter Pukl ◽  
Ales Groselj ◽  
Aleksandar Anicin ◽  
Primoz Strojan ◽  
...  
Keyword(s):  
Skull Base ◽  
Neck Dissection ◽  
Temporal Bone ◽  
Free Flap ◽  
Radical Neck Dissection ◽  
Selective Neck Dissection ◽  
Flap Reconstruction ◽  
Referral Centre ◽  
Regional Flap ◽  
Lateral Skull Base

Abstract Background The aim of the study was to identify the value of extensive resection and reconstruction with flaps in the treatment of locoregionally advanced lateral skull-base cancer. Patients and methods The retrospective case review of patients with lateral skull-base cancer treated surgically with curative intent between 2011 and 2019 at a tertiary otorhinolaryngology referral centre was made. Results Twelve patients with locoregionally advanced cancer were analysed. Lateral temporal bone resection was performed in nine (75.0%), partial parotidectomy in six (50.0%), total parotidectomy in one (8.3%), ipsilateral selective neck dissection in eight (66.7%) and ipsilateral modified radical neck dissection in one patient (8.3%). The defect was reconstructed with anterolateral thigh free flap, radial forearm free flap or pectoralis major myocutaneous flap in two patients (17.0%) each. Mean overall survival was 3.1 years (SD = 2.5) and cancer-free survival rate 100%. At the data collection cut-off, 83% of analysed patients and 100% of patients with flap reconstruction were alive. Conclusions Favourable local control in lateral skull-base cancer, which mainly involves temporal bone is achieved with an extensive locoregional resection followed by free or regional flap reconstruction. Universal cancer registry should be considered in centres treating this rare disease to alleviate analysis and multicentric research.

scholarly journals Blindness after laryngectomy and bilateral neck dissection in a diabetic patient: case report

2001 ◽  
Vol 119 (5) ◽  
pp. 181-183 ◽  
Author(s):  
Rui Celso Martins Mamede ◽  
David Livingstone Alves Figueiredo ◽  
Fabrício Villela Mamede
Keyword(s):  
Case Report ◽  
Diabetic Patient ◽  
Neck Dissection ◽  
Total Laryngectomy ◽  
Malignant Tumors ◽  
Rare Complication ◽  
Radical Neck Dissection ◽  
Selective Neck Dissection ◽  
Intraoperative Hypotension ◽  
The Right

CONTEXT: Neck dissection that accompanies resection of the primary lesion in malignant tumors of the upper aerodigestive tracts may cause complications inherent to the procedure or to prolongation of surgical time, increasing the risks for the patient. Among the complications that might occur is blindness, a rare complication with only 10 cases reported in the literature thus far. OBJECTIVE: To present the case of a diabetic patient submitted to total laryngectomy and modified and selective neck dissection that resulted in blindness. CASE REPORT: The authors report on a patient submitted to total laryngectomy and selective neck dissection on the left side, and modified radical neck dissection on the right, who developed blindness. This was probably due to intraoperative hypotension plus the contribution of decompensated diabetes mellitus and thrombosis of the internal jugular vein on the right side. The possible causes, risk factors and care to be taken to prevent this rare but highly debilitating complication are discussed.

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