Regional Failures after Selective Neck Dissection in Previously Untreated Squamous Cell Carcinoma of Oral Cavity

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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Choice of Levels in Selective Neck Dissection and Its Impact On Regional Control and Survival in 661 Patients With Head and Neck Squamous Cell Carcinoma

10.21203/rs.3.rs-667635/v1 ◽

2021 ◽

Author(s):

Mattis Bertlich ◽

Nina Zeller ◽

Saskia Freytag ◽

Bernhard G. Weiss ◽

Martin Canis ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Oral Cavity ◽

Cell Carcinoma ◽

Head And Neck ◽

Neck Dissection ◽

Squamous Cell ◽

Primary Treatment ◽

Selective Neck Dissection ◽

Regional Control ◽

Level I

Abstract Background: Selective Neck Dissection (SND) is the surgical treatment of choice in suspected or manifest nodal positive squamous cell carcinoma of the head and neck (HNSCC). For SND to be successful, treated levels should be selected accordingly. Aim of this study was to identify neck dissection levels that had an impact on the individual prognosis.Methods: We conducted a retrospective review of SND as part of primary treatment of HNSCC. Overall survival (OS) and regional control rates (RCR) were calculated for all patients.Results: 661 patients with HNSCC were included, 644 underwent ipsilateral and 319 contralateral SND. Average follow up was 78.9 ± 106.4 months. 67 (10.1%) patients eventually developed nodal recurrence. Tumor sites were oral cavity (135), oropharynx (179), hypopharynx (118) and larynx (229). Tumor categories pT1 – pT4a, and all clinical and pathological nodal categories were included. Multivariate analysis indicated improved OS rates for patients undergoing SND in ipsilateral levels I and V as well as level III contralaterally. Analysis for tumor origin showed that SND in ipsilateral level I showed a significantly improved OS in HNSCC of the oral cavity.Conclusion: In HNSCC of the oral cavity, ipsilateral level I needs to be included when performing SND.

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Selective Neck Dissection for Clinically Node-Positive Oral Cavity Squamous Cell Carcinoma

Yonsei Medical Journal ◽

10.3349/ymj.2013.54.1.139 ◽

2013 ◽

Vol 54 (1) ◽

pp. 139 ◽

Cited By ~ 15

Author(s):

Yoo Seob Shin ◽

Yoon Woo Koh ◽

Se-Heon Kim ◽

Eun Chang Choi

Keyword(s):

Squamous Cell Carcinoma ◽

Oral Cavity ◽

Cell Carcinoma ◽

Neck Dissection ◽

Squamous Cell ◽

Selective Neck Dissection ◽

Node Positive ◽

Clinically Node Positive

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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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