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PubMedDate not supplied

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

BACKGROUND: When the primary tumor in the larynx or hypopharynx responds well to radiotherapy, nodal metastasis in the neck may persist or recur. The primary site is usually left alone when no lesion is evident, but its long-term control is uncertain. METHODS: Radical neck dissection was performed in 23 patients who had nodal metastasis, while the primary tumor in the larynx or hypopharynx was controlled after radiotherapy. The primary site was left alone and kept under surveillance. RESULTS: Seven patients (30%) had recurrence at the primary site on follow-up. Two significant risk factors for development of recurrences at the primary site were identified; the neck node staging at presentation (p < 0.03) and presentation with persistent neck lymph nodes (p < 0.03). The 2-year survival of those patients with recurrences at the primary site was 29%. CONCLUSION: Radical neck dissection alone was justified, but close surveillance of the primary site after surgery is mandatory, especially for those patients with high-risk factors.

Adult↗
PubMed2006

Molecular assessment of neck dissections supports preserving level IIB lymph nodes in selective neck dissection for laryngeal squamous cell carcinoma with a clinically negative neck.

OBJECTIVES: It was the aim of this study to determine whether level IIB lymph nodes can be saved in elective neck dissection as a treatment for patients with squamous cell carcinoma (SCC) of the larynx. We present a prospective analysis of a case series. METHODS: Thirty-one patients with SCC of the larynx and without palpable lymph nodes at the neck who underwent an elective neck dissection were prospectively studied. The incidence of micrometastasis to level IIB lymph nodes after performing elective neck dissection was evaluated by nested reverse transcription polymerase chain reaction for cytokeratin (CK)19 and CK20 as well as by pathological examination. RESULTS: Nested reverse transcription polymerase chain reaction for CK19 and CK20 mRNA presented similar results but differed from the pathological examination. Of the 31 patients, 6 (19%) by pathological analysis and 9 (29%) by molecular analysis had lymph nodes positive for metastatic SCC. By molecular analysis, only 1 of the 31 patients had involvement of level IIB lymph nodes. CONCLUSIONS: This region may be preserved in elective neck dissection in patients with SCC of the larynx, so that accessory nerve dysfunction can be minimized and operative time can be saved.

Carcinoma, Squamous Cell↗
PubMed2005

Incidence and significance of clinically unsuspected thyroid tissue in lymph nodes found during neck dissection in head and neck carcinoma patients.

OBJECTIVES/HYPOTHESIS: The objectives were to quantify the incidence of clinically unsuspected thyroid tissue in cervical lymph nodes encountered during neck dissection in patients with head and neck carcinoma, to describe the location and histological aspect of these inclusions, and to assess their clinical significance. STUDY DESIGN: Retrospective study. METHODS: The histological records of 1123 neck dissections in 752 patients with head and neck carcinoma were reviewed. In cases with thyroid inclusions, the pathological diagnosis was reviewed and an immunohistochemical study against thyroglobulin and calcitonin was carried out. RESULTS: Clinically unsuspected thyroid tissue was found in lymph nodes in 11 of the 752 patients with head and neck carcinoma treated with neck dissection. In five cases, the thyroid inclusion was compatible with a metastases of an occult papillary thyroid carcinoma. In the other six cases, a collection of thyroid follicles without malignant characteristics was found beneath the lymph node capsule. These latter cases were considered benign thyroid inclusions. A thyroidectomy was performed in three of the patients with lymph node metastases of the papillary carcinoma. An occult papillary carcinoma was found in only one case. The other two patients had been treated previously with radiotherapy for an early-stage glottic carcinoma. Immunohistochemical study did not find calcitonin-positive cells within the benign thyroid inclusions. After a follow-up period ranging from 1.2 to 8.2 years, no patient had any kind of local, regional, or distant relapse related to the thyroid disease. CONCLUSION: The incidence of unsuspected thyroid tissue in lymph nodes of patients with head and neck carcinoma treated with neck dissection was 1.5%. Both lymph node metastases of a papillary carcinoma and benign thyroid inclusions were found. The study results suggest that the incidental finding of thyroid tissue in the lymph nodes during a neck dissection in patients with head and neck carcinoma does not necessarily indicate the need for aggressive therapy.

Adult↗
PubMed1998

Transverse sinus thrombosis and venous infarction of the brain following unilateral radical neck dissection.

Radical neck dissection is one of the commonest procedures performed in any unit dealing with head and neck surgery. Intracranial complications following this procedure are uncommon. Transverse sinus thrombosis and venous infarction of the brain following unilateral radical neck dissection have not been reported in the literature. We present a case in which this complication occurred following an uneventful radical neck dissection.

Aged↗
PubMed1975

Radical neck dissection.

Radical neck dissection has evolved into a standard surgical technique over the past century. It has been the most effective method of attempting to control suspected or gross metastasis to the cervical region. The technique embraces the en masse removal of all tissue elements in the space between the subdermis and the fascia colli. The perimeters of the dissection extend from the midline anteriorly to the anterior border of the trapezius muscle posteriorly, and from the clavicle to the mandible. The essential portion of this large mass of tissue is the cervical lymph system with its lymph nodes and afferent and efferent connecting vessels. Controllability of the cancer process is in direct proportion to the number of nodes involved, their size and their position in the neck. Complications in the routine radical neck dissection are minimal. Cure rates are influenced by the type, size and site of the primary cancer, the possibilities for the adjunctive treatment such as radiotherapy and chemotherapy, and the, as yet, little understood immunological factors. The radical neck dissection has proven itself to be an essential tool in the management of cancer in the head and neck.

Accessory Nerve↗
PubMed2000

Endoscopic neck dissection in an animal model: comparison of nodal yield with open-neck dissection.

OBJECTIVE: To evaluate the possibility, complications, and efficacy of endoscopic neck dissection (END) in a porcine model. DESIGN: Experimental self-controlled study. SUBJECTS: Minipigs. INTERVENTION: Endoscopic neck dissection was performed using general anesthesia with techniques adapted from laparoscopic surgery. The tissue specimens removed were divided according to porcine equivalents of human neck groups. After the completion of END, open-neck dissection was performed using standard surgical techniques, and the remaining tissue within each neck group was retrieved. A pathologist evaluated each specimen without knowing its exact origin in terms of neck group or side and the type of surgical technique used. For each specimen, the number of retrieved lymph nodes and their anatomical integrity were analyzed. RESULTS: Ten neck dissections were performed in 8 minipigs without any major complications. The number of retrieved lymph nodes by END was 18.4 +/- 7.4 (mean +/- SD). Completed open-neck dissection retrieved an additional 3.3 +/- 1.8 lymph nodes. The efficacy rate of END was 88% +/- 10% (+/ -SD). The majority of retrieved lymph nodes were intact, with less than 5% of nodes exhibiting crushing artifacts. CONCLUSIONS: Endoscopic neck dissection in a porcine model seems to be free of major complications and able to retrieve the majority of neck lymph nodes. A larger number of animals and their survival need to be studied before human studies can begin.

Animals↗
PubMed1986

Squamous cell carcinoma of the head and neck treated with radiation therapy: the role of neck dissection for clinically positive neck nodes.

This is an analysis of 161 patients with squamous cell carcinoma of the head and neck treated with irradiation to the primary site and neck followed by a neck dissection(s) for clinically positive neck nodes. Patients were treated between October 1964 and December 1982; there was a minimum 2-year follow-up. Fifty-two patients were deleted from analysis of neck disease control because they died of intercurrent disease or cancer less than 2 years from treatment with the neck continuously disease-free. All patients are included in the analysis of complications. Neck disease control rate was the same for radiation plus neck dissection or radiation therapy alone for solitary nodes less than 3 cm. As the size and number of nodes increased, there was a higher rate of neck disease control for combined treatment as compared with irradiation alone. The neck disease control rate, size for size, was lower for patients with fixed nodes and for those with residual tumor in the pathologic specimen. There was no difference in neck disease control as a function of the interval between irradiation and neck dissection. For nodes less than or equal to 6 cm, a minimum node dose of 5000 rad appeared to be sufficient for control, whereas for nodes greater than 6 cm, at least 6000 rad appeared to be required for optimal control. Fixed nodes required a higher dose compared to mobile masses. The incidence of postoperative complications was increased with maximum subcutaneous doses of greater than or equal to 6000 rad. There was also an increased incidence of postoperative complications for patients undergoing simultaneous, as compared with staged, bilateral neck dissection.

Carcinoma, Squamous Cell↗
PubMed2002

[Indication and clinical radical effect of functional neck dissection for head and neck neoplasm].

BACKGROUND & OBJECTIVE: The functional neck dissection was first described by Bocca in 1967. It has been used on clinical practice for years. But still controversial between supporters and opponents of functional neck dissection. This study was designed to evaluate application and radical effectiveness of functional neck dissection(FND). METHODS: One hundred and fifty-two cases underwent FND were reviewed with analysis of pathological specimen and follow-up data. RESULT: One hundred and fifty-two cases of FND include tongue carcinoma 20 cases, larynx carcinoma 23 cases, thyroid papillary adenocarcinoma 96 cases, follicular adenocarcinoma 9 cases, medullary adenocarcinoma 4 cases; Five years recurrence rate of tongue and larynx carcinoma was 12.5%, 14.3%, 40.0% and 20%, 16.7%, 50.0% in N0, N1, N2, respectively. 5 years recurrence rate of thyroid papillary adenocarcinoma is 6.5%, 7.1% in N1a, N1b, respectively. CONCLUSION: Functional neck dissection is suitable for head and neck neoplasm, was result in satisfactory radical effects.

Adenocarcinoma, Follicular↗
PubMed2000

Indications for selective neck dissection: when, how, and why.

Selective neck dissection is a procedure that is primarily indicated in patients with clinically negative nodal disease in which there is a high risk of occult metastases. Others have advocated its use for patients with positive nodes, although under very specific circumstances and in combination with postoperative radiation therapy. The type of selective neck dissection performed varies according to the site of the primary, because the pattern of metastases is unique in each case. This review presents the author's philosophy on when, how, and why to employ the procedure, based on the location of primary cancers at oral, pharyngeal, laryngeal, cutaneous, thyroid, and salivary gland sites.

Head and Neck Neoplasms↗
PubMed2004

Incidence of perioperative stroke after neck dissection for head and neck cancer: a regional outcome analysis.

OBJECTIVE: To determine the incidence of perioperative stroke in patients undergoing a neck dissection. SUMMARY BACKGROUND DATA: The incidence of perioperative stroke in non-head and neck surgery is between 0.08 and 0.2%. In contrast, a critical review of the literature identified 2 studies stating the incidence of perioperative stroke in head and neck surgery to be 3.2% and 4.8%. The implications of these results are significant because they suggest a potential need for preoperative screening and/or intervention for carotid artery pathology. METHODS: This historical cohort study was conducted using discharge data for all neck dissections performed in a geographically-defined health region in Alberta, Canada, from 1994 to 2002. Subjects were selected for study if they had an assigned ICD-9CM procedure code for a neck dissection at one of the region's 3 adult-care hospitals. Our main outcome measure was perioperative stroke. RESULTS: Patients (n = 499) were identified as having had a neck dissection (mean age 56.5 +/- 15.3 SD, 65.3% male). Seven patients had ICD-9CM codes for postoperative central nervous system complications (incidence of 1.4%). However, on chart review, only one had had a true perioperative stroke corresponding to an incidence of 0.2% (95% confidence interval 0.01, 1.12). No missed strokes were found in a confirmatory random review of 10% of charts. CONCLUSIONS: The incidence of perioperative stroke in this study is significantly lower than that previously stated in the literature. This suggests that preoperative screening and/or intervention for carotid artery disease may not be necessary in this patient population.

Female↗
PubMedDate not supplied

Planned postradiotherapy bilateral neck dissection for head and neck cancer.

PURPOSE: This is a retrospective analysis of 50 patients with squamous cell carcinoma of the head and neck treated with radiotherapy (RT) to the primary site and bilateral neck followed by a planned bilateral neck dissection approximately 4 to 6 weeks after completion of RT. PATIENTS AND METHODS: Between November 1964 and March 1997, 50 patients underwent bilateral neck dissections after RT, with minimum 2-year follow-up. Forty-eight patients had bilateral positive neck nodes. RESULTS: At 5 years, the rates of neck disease control, local-regional control, and cause-specific survival were 76%, 70%, and 39%, respectively. Five severe complications developed after surgery, and 1 developed after RT. CONCLUSIONS: Radiotherapy followed by a planned bilateral neck dissection resulted in a high rate of local-regional control with acceptable morbidity. The likelihood of severe complications after simultaneous (as opposed to staged) neck dissection was not significantly different (P =.24).

Carcinoma, Squamous Cell↗
PubMed2003

Perioperative stroke occurring in patients who undergo neck dissection for head and neck cancer: unanswered questions.

Stroke represents a major cause of disability among middle-aged and elderly people. Carotid artery stenosis is an important risk factor for stroke and is prevalent in elderly men with hypertension, diabetes mellitus, and those who smoke or have atherosclerotic disease, or both. Patients who undergo neck dissection for head and neck cancer may have some or all of the above characteristics and may experience surgical manipulation of the carotid arteries. This combination of medical and surgical factors may predispose such patients to perioperative stroke. A critical review of the literature was completed to determine the incidence of stroke perioperatively in patients undergoing a neck dissection for head and neck cancer. We found 2 studies that quoted the risk of stroke to be between 3.2% and 4.8%. The implications of these results are significant because they suggest a need for preoperative screening (with Doppler ultrasonography) or intervention (with carotid endarterectomy), or both. However, the quality of these 2 studies is such that future research is first needed to define the rate of stroke in head and neck surgery.

Adult↗
PubMed1994

The impact of patterns of nodal metastasis on modifications of neck dissection.

BACKGROUND: Radical neck dissection (RND) is standard treatment for cervical metastasis from head and neck cancer. Although effective, RND produces significant morbidity. In an effort to reduce this morbidity, modifications of RND have been developed. These modifications can be comprehensive yet spare some or all of the nonlymphatic structures removed in RND, or they can remove less than all the lymph node groups removed in RND and are termed selective neck dissections. We have reviewed the literature regarding the patterns of nodal metastasis from head and neck cancer to define the indications for these modifications of RND. METHODS: A review of the literature concerning patterns of nodal metastasis from head and neck cancer was performed. Using this information, recommendations on the use of modifications of neck dissection were formulated. RESULTS: In squamous cancers, with clinically negative neck supraomohyoid neck dissection is an adequate node sampling procedure for oral cavity and oropharyngeal lesions, and lateral (jugular) neck dissection for primary lesions of the hypopharynx, and larynx. In the clinically positive neck comprehensive neck dissection with preservation of the spinal accessory nerve is oncologically sound. CONCLUSIONS: Nodal metastasis of head and neck cancer occurs in predictable patterns. Based on these patterns of nodal metastasis, recommendations for the use of modifications of neck dissection are presented.

Head and Neck Neoplasms↗
PubMed2000

Combined radiotherapy with planned neck dissection for small head and neck cancers with advanced cervical metastases.

BACKGROUND: We have previously described our treatment algorithm for patients with small head and neck cancers with advanced cervical metastases (stage N2 or greater). Primary radiotherapy is given to the primary site and neck, followed 6 weeks later with endoscopy and biopsy of the primary site. If biopsy of the primary site is negative by frozen section, an immediate neck dissection is performed even when no clinical residual neck disease is present. Our initial review found that 36% of patients with a complete clinical response to radiotherapy had positive nodes on histological examination. STUDY DESIGN: Retrospective. METHODS: The medical records of 71 patients treated at UCLA Medical Center from 1986 to 1999 by this algorithm were reviewed. RESULTS: After radiotherapy, 69 of 71 patients had a complete response at their primary site. Forty-two patients had a complete clinical response in the neck. Seventy-one neck dissections were performed. Overall, 31 of 71 neck dissections (44%) had positive nodes. Among the 42 patients with a complete response to radiotherapy, 13 (31%) had positive histological nodes. Among the 29 patients with a partial response to radiotherapy, 17 (59%) had positive nodes. Follow-up and incidence of neck recurrence are discussed. CONCLUSION: Planned neck dissection for advanced cervical metastases remains controversial for patients with a complete clinical response to radiotherapy. However, our results suggest that clinical assessment after radiotherapy cannot assure the absence of neck disease. Until there are reliable methods to distinguish which patients are truly free of neck disease, we believe the benefits of a planned neck dissection outweigh the low morbidity of this procedure.

Adult↗
PubMed1989

Development of significant sternoclavicular joint hypertrophy following radical neck dissection.

Radical neck dissection (RND) has proved to be effective in the en bloc removal of metastatic lymph nodes in the neck. This paper describes a case with severe sternoclavicular joint hypertrophy following RND. This condition should be differentiated both clinically and radiologically from metastases of the head of the clavicle. Computed tomography was found to be of value in the diagnosis of the condition.

Aged↗
PubMed1997

Planned early neck dissection before radiation for persistent neck nodes after induction chemotherapy.

Optimal management of advanced neck metastases as part of an organ preservation treatment approach for head and neck squamous carcinoma (HNSC) is unclear. Since 1989, our management paradigm for patients on organ preservation was modified to incorporate planned early neck dissection before radiation therapy for patients who did not achieve a complete response (CR) of neck nodes after induction chemotherapy (IC). The purpose of this study was to determine if planned early neck dissection is a safe and effective approach in the management of advanced nodal disease as part of organ preservation. Fifty-eight consecutive patients with advanced HNSC who were entered in organ preservation trials using induction chemotherapy and radiation with surgical salvage were studied. Median follow-up was 26 months. Of the 58 patients, 71% were stage IV. Patients were grouped by nodal response to chemotherapy and N class, and were analyzed with respect to patterns of recurrence, complications, and survival. Overall, the rate of CR of neck nodes was 49%. Fifty-one percent had less than a complete response of neck nodes after IC and required planned early neck dissection. There were no significant differences in patterns of recurrence, complications, interval time to start of radiation, recurrence, or survival rates between the CR and less than CR groups. These data suggest that planned early neck dissection for patients with less than CR in the neck after IC is not detrimental with respect to neck relapse or overall survival. We believe that planned early neck dissection can be safely incorporated into future organ preservation treatment protocols for patients with advanced head and neck carcinoma.

Adult↗
PubMed1976

Radical neck dissection.

Radical neck dissection was described in 1906, and the following half century saw it being increasingly accepted without any significant change. More recently a number of differing concepts have arisen. While the value of the original radical operation is established, the more recent modifications are not yet substantiated by proper trials.

Carcinoma, Squamous Cell↗