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 Sentinel lymph node in supraglotic larynx cancer

2009 ◽  
Vol 56 (3) ◽  
pp. 117-120
Author(s):  
V.Z. Djordjevic ◽  
M.V. Dimitrijevic ◽  
S.D. Jesic ◽  
Z.M. Petrovic ◽  
N.A. Arsovic ◽  
...  
Keyword(s):  
Lymph Node ◽  
Survival Rate ◽  
Sentinel Lymph Node ◽  
Postoperative Radiotherapy ◽  
Selective Neck Dissection ◽  
Occult Metastases ◽  
Primary Surgery ◽  
Level Ii ◽  
Negative Findings ◽  
Node Metastases

The treatment of patients with supraglottic laryngeal cancer still remains a controversal issue. The study comprised 193 patients with a supraglottic laryngeal carcinoma treated in the period 1986 - 2003. All patients had primary surgery. They all had clinically and ultrasono-grafically negative findings in the neck (N0). Bilateral selective neck dissection at the level II-III was performed in all patients at the time of primar surgery. Postoperative radiotherapy was given to all patients with verified occult metastases (60 Gy).The occult cervical node metastases were found in 18% (35/193). Ipsilateral occult metastases were more common (77%, 27/35), but both bilateral and contralateral spread was also seen (14%, 5/35 and 9%, 3/35, respectively). Only in two (1%) did metastases develop subsequently. The 5-years survival rate was 86%.

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 Long-Term Outcomes of Breast Cancer Patients Who Underwent Selective Neck Dissection for Metachronous Isolated Supraclavicular Nodal Metastasis

Cancers ◽  
2021 ◽  
Vol 14 (1) ◽  
pp. 164
Author(s):  
Shin-Cheh Chen ◽  
Shih-Che Shen ◽  
Chi-Chang Yu ◽  
Ting-Shuo Huang ◽  
Yung-Feng Lo ◽  
...  
Keyword(s):  
Neck Dissection ◽  
Distant Metastasis ◽  
Primary Tumor ◽  
Medical Center ◽  
Significant Risk ◽  
Nodal Metastasis ◽  
Time Interval ◽  
Selective Neck Dissection ◽  
Tumor Surgery ◽  
Breast Cancer Patients

We retrospectively enrolled 139 patients who developed metachronous isolated supraclavicular lymph node metastasis (miSLNM) from 8129 consecutive patients who underwent primary surgery between 1990 and 2008 at a single medical center. The median age was 47 years. The median follow-up time from date of primary tumor surgery was 73.1 months, and the median time to the date of neck relapse was 43.9 months in this study. Sixty-one (43.9%) patients underwent selective neck dissection (SND). The 5-year distant metastasis-free survival (DMFS), post-recurrence survival, and overall survival (OS) rates in the SND group were 31.1%, 40.3%, and 68.9%, respectively, whereas those of the no-SND group were 9.7%, 32.9%, and 57.7%, respectively (p = 0.001). No SND and time interval from primary tumor surgery to neck relapse ≤24 months were the only significant risk factors in the multivariate analysis of DMFS (hazard ratio (HR), 1.77; 95% confidence interval (CI), 1.23–2.56; p = 0.002 and HR, 1.76, 95% CI, 1.23–2.52; p = 0.002, respectively) and OS (HR, 1.77; 95% CI, 1.22–2.55; p = 0.003 and HR, 3.54, 95% CI, 2.44–5.16; p < 0.0001, respectively). Multimodal therapy, including neck dissection, significantly improved the DMFS and OS of miSLNM. Survival improvement after miSLNM control by intensive surgical treatment suggests that miSLNM is not distant metastasis. 

scholarly journals Distribucija cervikalnih metastaza karcinoma cervikofacijalne regije

2004 ◽  
Vol 51 (1) ◽  
pp. 83-87 ◽  
Author(s):  
Aleksandar Trivic ◽  
S. Krejovic-Trivic ◽  
Jovica Milovanovic ◽  
Vojko Djukic ◽  
Nenad Arsovic ◽  
...  
Keyword(s):  
Oral Cavity ◽  
Primary Tumor ◽  
Primary Tumors ◽  
Facial Region ◽  
Cervical Metastases ◽  
Posterior Triangle ◽  
Level Ii ◽  
Level I ◽  
Regional Disease

The primary goal in the therapy of patients with cervico-facial cancers has been always the control of loco-regional disease. It is more difficult to control metastasis than primary tumor. According to numerous authors, metastases to cervical lymphonodus reduce the survival of patients with planocellular cancer of the upper aero-digestive pathways for about 50%. Precise classification of primary tumor and regional lymphonodus is highly significant for adequate and timely treatment of patients with cancers of cervico-facial region. The objective of our study was to make clinical classification of cervico-facial tumors and to establish the distribution of nodes according to node groups and cervical levels. In our series of 319 subjects, T2 category of primary tumors was most prevalent accounting for 40.44%. Clinically palpable lymphonodes were found in 87.15%, with most prevalent N1 category accounting for 42.95%. The incidence of clinically negative cervical nodus (NO) was reported in 12.85%. The nodes of the upper, medium and lower jugular group were most frequent in cancers of the larynx and pharynx. In cancer of the oral cavity, submental and submandibular nodes were the most commonly involved. In distribution of nodes based on oncological cervical levels, 45.86% of nodes at level II of the neck were found in laryngeal cancer, while 40% the neck level I was involved in the cancer of the oral cavity. In epipharyngeal cancer, 3.15% of cervical metastases were detected in the posterior triangle of the neck. The incidence of cervical metastases in specific primary localizations has a significant role for indications of one of the dissections of the neck.

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.

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.

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