scholarly journals 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

Author(s):  
Mattis Bertlich ◽  
Nina Zeller ◽  
Saskia Freytag ◽  
Bernhard G. Weiss ◽  
Martin Canis ◽  
...  

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.

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Hassan Iqbal ◽  
Abu Bakar Hafeez Bhatti ◽  
Raza Hussain ◽  
Arif Jamshed

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.


2016 ◽  
Vol 131 (S1) ◽  
pp. S36-S40 ◽  
Author(s):  
R S Lim ◽  
L Evans ◽  
A P George ◽  
N de Alwis ◽  
P Stimpson ◽  
...  

AbstractBackground:Nodal metastasis is an important prognostic factor in head and neck squamous cell carcinoma. This study aimed to determine the average nodal basin yield per level of neck dissection, and to investigate if age, gender, body mass index, tumour size, depth of tumour invasion and p16 status influence nodal yield.Method:A retrospective review of 185 patients with head and neck squamous cell carcinoma generated 240 neck dissection specimens.Results:The respective mean nodal yields for levels I, II, III, IV and V were 5.27, 9.43, 8.49, 7.43 and 9.02 in non-cutaneous squamous cell carcinoma patients, and 4.2, 7.57, 9.65, 4.33 and 12.29 in cutaneous squamous cell carcinoma patients. Multiple regression analysis revealed that p16-positive patients with mucosal squamous cell carcinoma yielded, on average, 2.4 more nodes than their p16-negative peers (p = 0.04, 95 per cent confidence interval = 0.116 to 4.693). This figure was 3.84 (p = 0.008, 95 per cent confidence interval = 1.070 to 6.605) for p16-positive patients with oral cavity squamous cell carcinoma.Conclusion:In mucosal squamous cell carcinoma, p16-positive status significantly influenced nodal yield, with the impact being more pronounced in oral cavity squamous cell carcinoma patients.


2012 ◽  
Vol 270 (4) ◽  
pp. 1195-1202 ◽  
Author(s):  
K. Thomas Robbins ◽  
Alfio Ferlito ◽  
Jatin P. Shah ◽  
Marc Hamoir ◽  
Robert P. Takes ◽  
...  

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