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At least 451 records · Page 25Linked to original sources
PubMed2001

Impact of modified radical neck dissection on biochemical cure in medullary thyroid carcinomas.

BACKGROUND: This study evaluated the outcome of total thyroidectomy and modified radical neck dissection in primary treatment of patients with medullary thyroid carcinoma (MTC). METHODS: Thirty-six patients with sporadic (n = 16) and hereditary (n = 20) MTC underwent thyroidectomy and systematic central and lateral lymph node dissection (unilateral, 23; bilateral, 13) between 1994 and 2000. Postoperative serum calcitonin levels were correlated with immediate or delayed surgery, tumor categories, and lymph node metastases. RESULTS: Sixteen of 36 (44%) patients with clinically evident MTC treated with central and lateral neck dissection exhibited normal basal and stimulated calcitonin levels at a median follow-up of 3.7 years. Lymph node involvement was detected in 75% of these patients and correlated with the TNM stages. Biochemical cure was achieved according to the T categories in 83% of the patients in stage T1, 42% in stage T2, and none of the patients in stage T4 (P = .011). Basal and stimulated calcitonin levels were found to be normal in 89% of the patients without lymph node involvement and in 30% of the patients with lymph node metastases (P = .005). CONCLUSIONS: Screening for MTC and primary treatment with total thyroidectomy and modified radical neck dissection are essential for biochemical cure of MTC.

Adolescent↗
PubMed1991

Radical neck dissection in nasopharyngeal carcinoma.

We report a series of 37 patients who had radical neck dissection for residual or recurrent lymph node metastasis from nasopharyngeal carcinoma after radiotherapy. The operation was performed despite high doses of pre-operative radiotherapy. There was no operative mortality and the morbidity was 13% (2 prolonged chylous drainage, 3 sloughing of neck flap). The risk of sloughing of neck flap was significantly related to previous lymph node biopsy, which should be avoided if at all possible. In 35% of patients, the lymph node was densely adherent to neighbouring structures. In the 28 patients who had single lymph node clinically, 29% had multiple neck node involvement noted during operation; another 14% were documented only on histological examination. Radical neck dissection rather than excision alone is justified for the clinically solitary lymph node.

Adult↗
PubMed2002

Sudden death after neck dissection for cancer.

The goal of this study was to analyze the mortality data following neck dissection and determine the risk factors of early death. The hospital mortality records were analyzed from 3,015 consecutive patients who underwent neck dissection. A case control study analyzed risk factors of death during the first 3 postoperative days. The mortality incidences were 0.50% and 1.33%, respectively, during the first 3 and the first 30 postoperative days. Eleven of the 12 unexplained deaths occurred during the first 3 postoperative days, and most of these patients died suddenly. They were more likely to be alcoholic and to have undergone nerve section. In most of the patients who died after the third postoperative day, death was related to a postoperative complication. Although the mechanisms of sudden death remain unclear, careful follow-up of these patients during the early postoperative days should be performed to reduce the mortality risk by shortening the delay of care.

Aged↗
PubMed2003

Endoscopic selective neck dissection in a porcine model.

OBJECTIVE: To investigate the feasibility of accomplishing a selective neck dissection (SND) endoscopically. STUDY DESIGN: Prospective, nonrandomized experimental investigation in a porcine model. METHODS: Unilateral endoscopic SNDs were performed in Yorkshire pigs. A spacious operative pocket was developed using a combination of hernia balloon expansion followed by low-pressure (4 mm Hg) carbon dioxide insufflation. The sternomastoid muscle, thymus, submandibular gland, lymph nodes, and fibrofatty tissue were removed in a procedure approximating a human SND. Data (operative time, blood loss, arterial blood gas values, weight of the specimen, and complications) were prospectively recorded. The specimens were analyzed by a pathologist, and the number and size of lymph nodes were recorded. RESULTS: Fourteen endoscopic SNDs were successfully performed. No conversions to open surgery were necessary. The median operative time was 131 minutes (range, 95-235 minutes). The median estimated blood loss was 4 mL (range, 0-150 mL). The mean +/- SD specimen weight was 42.9 +/- 8.3 g; the mean number +/- SD of nodes retrieved from the neck specimen was 4.8 +/- 2.2, and the mean +/- SD maximal nodal dimension was 2.4 +/- 0.5 cm. The arterial PCO2 increased by an average of only 3.9 mm Hg from the beginning to the end of the surgery; correspondingly, the pH fell by only 0.02. There were no major complications, and no animals had to be euthanized prior to the completion of the procedure. CONCLUSIONS: Endoscopic neck dissection in a porcine model can be accomplished with a combination of strategies to overcome the dilemma of creating and maintaining an operative pocket. The merger of SND with endoscopic technology offers the promise of truly minimally invasive surgery for the node-negative neck.

Anesthesia↗
PubMed2003

Neck dissection shoulder syndrome: quantification and three-dimensional evaluation with an optoelectronic tracking system.

Objective 3-dimensional biomechanical changes of the shoulder at rest or during arm elevation were measured by means of a new specific method using an optoelectronic detection system that was developed for computer-aided surgery. Additionally, the shoulder syndrome following neck dissection was evaluated by the recognized orthopedic shoulder Constant score. The statistical evaluation encompassed 12 patients with unilateral radical neck dissection (RND), 12 patients with unilateral modified radical neck dissection (MRND) with preservation of the accessory nerve, and 10 healthy subjects. The healthy shoulders showed normal kinematic behavior, the so-called "scapulohumeral rhythm" (SHR). After MRND, the static scapular position and SHR showed no significant 3-dimensional variations. In contrast, RND produced a highly significant scapular displacement at rest (p < .01) and a near-total abolition of SHR. The Constant scores were significantly lower after RND than after MRND (p < .01). Three-dimensional evaluation of the shoulder syndrome supports the Constant score, quantifying what can be measured objectively.

Accessory Nerve↗
PubMedDate not supplied

The use of unilateral deep plane neck lifting to improve the aesthetic appearance of the neck dissection deformity.

The primary concerns of head and neck cancer surgeons are, and should remain, the complete extirpation of tumor and the prevention of tumor recurrence. In recent years, numerous advances have been made in the reconstruction of this patient population, significantly improving their functional and aesthetic outcomes. In this article, with an illustrative case example, we present our technique of unilateral deep plane neck lift that may be considered when one is attempting to achieve better symmetry in patients after radical neck dissection.

Carcinoma, Squamous Cell↗
PubMed1996

The posterolateral neck dissection. Technique and results.

OBJECTIVE: To evaluate the effectiveness of the posterolateral neck dissection in providing regional control of metastatic disease to the posterior triangle from head and neck primary tumors as part of a multidisciplinary treatment approach. DESIGN: A case series review of 55 patients treated over a 10-year period form 1982 through 1991 with a minimum of 3 years of follow-up. Factors evaluated included site and histologic type of primary tumors, extent of surgery performed, other therapies provided, pathologic findings, and clinical outcome. SETTING: The University of Texas M.D. Anderson Cancer Center, Houston. PATIENTS: Forty-six male and nine female patients were studied. Three of them had bilateral dissections, for a total of 58 operations. Thirty-five were diagnosed as having melanoma; 10, squamous cell carcinoma, and 10, various other histologic types. INTERVENTION: All patients underwent a posterolateral neck dissection, either alone or as part of a multidisciplinary treatment plan. OUTCOME MEASURES: Factors reviewed were recurrence, either at the primary site or at a regional site, development of distant metastases, and surgical morbidity. RESULTS: Our review showed that, overall, disease was controlled at the site of the primary tumor in 89% of patients (94% of patients with melanoma) and that regional disease was controlled in 93% of patients (89% of patients with melanoma). Surgical morbidity was minimal. CONCLUSION: The "functional" posterolateral neck dissection as practiced at the University of Texas M.D. Anderson Cancer Center is effective surgical therapy that provides control of regional metastatic disease to the posterior neck from head and neck primary tumors.

Adolescent↗
PubMed2000

[Bilateral neck dissections].

The structure of lymphatic system of the larynx causes that in some cases node metastases may occur bilaterally. In many patients bilateral neck dissection is indicated. In material of 252 patients with laryngeal carcinoma, treated in ENT Department in Gdańsk in 1976-1985, an assessment of frequency and indications to one-stage bilateral neck dissection was made. Among 252 patients, bilateral operations were performed in 50, i.e. 20%. We have found that in 29 patients of 50 were nodal metastases, in 12 unilateral and in 17 bilateral. The analysis of long-term results of treatment showed 23.5% of 5-year survivals in patients with bilateral metastases and 42.3% in patients with unilateral metastases. To base on these data we consider that bilateral one-stage neck dissection should be a standard treatment in many cases of laryngeal carcinoma.

Adult↗
PubMed2004

Modified radical neck dissection for differentiated thyroid cancer: operative technique.

Our standard surgical approach to patients with papillary thyroid cancer is subtotal thyroidectomy with modified radical neck dissection (MRND) on the affected side. MRND preserves the jugular vein, the sternocleidomastoid muscle, and the accessory nerve, effectively conserving function and cosmesis. Knowledge of the anatomy of the neck, precise staging, prognostic evaluation, and experience are needed for a surgeon to perform MRND. Radical neck dissection should not be performed unless the tumor invades the jugular vein and sternocleidomastoid muscle. Berry picking is not indicated for patients with thyroid cancer. The skin incision used is an extended collar incision. If lymph node metastasis is present at the upper bifurcation of the carotid artery, a modified MacFee incision is used. Taping of the carotid artery or sternocleidomastoid muscle is avoided unless the tumor invades these tissues. MRND is a safe procedure when performed by skilled, experienced surgeons.

Humans↗
PubMedDate not supplied

The value of elective neck dissection in treatment of cancer of the tongue.

PURPOSE: The "adequate" therapy of tongue cancer has not yet been determined. The authors report their experience with 58 N(0) patients to elucidate the role of elective neck dissection in surgical treatment of cancer of the tongue. MATERIALS AND METHODS: The files of 58 N(0) patients with tongue cancer were evaluated retrospectively. In every patient, partial glossectomy continuous with neck dissection was the mainstay of the treatment. TNM staging, intraoperative N staging, pathologically confirmed cervical lymph node metastases and their levels, and clinical outcomes (local and regional recurrences) were recorded. The sensitivity and specificity of intraoperative staging was determined. RESULTS: Fifty-four percent (31/58) of the patients presented as T(1), and 26% (15/58) as T(2). The overall occult metastasis rate was 29.3% (17/58). The occult metastasis rate for T(1) and T(2) lesions was 19.4% (6/31) and 26.7% (4/15), respectively. The sensitivity of intraoperative staging was 76.5%, and the specificity was 51.2%. CONCLUSIONS: The rate of occult metastasis to the neck is too high in all tongue cancer cases to take the risk of regional recurrence, and the surgeon can not solely depend on neck palpation for determination of neck metastasis. Radiologic investigations and fine-needle aspiration decrease, but never reduce to zero the rate of false-negative examination. There is an obvious indication for neck dissection, even in early cases.

Adult↗
PubMedDate not supplied

Indication for neck dissection in carcinoma of the parotid gland. Our experience on 39 cases.

In cases of parotid carcinoma, the percentage of cervical metastases, at the time of first observation is 18%. Consequently, the evaluation of the grade of lymphatic involvement is very important in order to plan a correct therapy. The authors underline the important role that neck dissection has in the treatment of these tumours. There are different points of view on neck dissection in cases of malignant parotid tumours. While there is no doubt with regard to indications on neck dissection in N + patients, the problem does exist for N-patients. The Authors have analyzed 39 patients with malignant parotid tumours observed at the Department of Maxillo-Facial Surgery of the "Federico II" University of Naples.

Adenocarcinoma↗
PubMed1989

Radical neck dissection: a subjective and objective evaluation of postoperative disability.

Nearly all patients who undergo radical neck dissection note significant morbidity if the XIth cranial nerve is sacrificed. Physicians can be misled to believe in a lower morbidity because the usual physical examination is unreliable in detecting weakness and because patients rarely persist in mentioning shoulder problems during follow-up visits. Eleven patients between the ages of 55 and 70, who had undergone unilateral neck dissection with sacrifice of the XIth cranial nerve, were given questionnaires and were objectively evaluated for strength and active range of motion on a Cybex II dynamometer. Eighty-two percent of patients experienced pain, 91% experienced weakness, and 91% experienced impairment on the affected side. Peak torque for the affected side ranged between 0 to 85% of the peak torque for the normal shoulder. Gravity-free active range of motions were 20 degrees to 162 degrees with 8 of 11 at 100 degrees or less. In all but two patients, the passive range of motion was limited by pain.

Accessory Nerve↗
PubMed1975

Transsternal radical neck dissection. Postoperative complications and management.

In 1962, Sisson et al reported the use of the transsternal radical neck dissection for carcinoma recurring in the peristomal area after laryngectomy. We have performed over 50 transsternal radical neck dissections in the past 14 years. A significant number of early cases succumbed to the postoperative problems of fistula, infection, and large vessel rupture. Our two cases illustrate intraoperative and postoperative complications. Management of these complications is discussed. Morbidity and mortality has decreased as we have gained experience in the management of these problems.

Aneurysm↗
PubMed1982

Fracture of the clavicle following radical neck dissection and postoperative radiotherapy: a case report and review of the literature.

The treatment of head and neck cancer with radiotherapy and radical neck dissection has many recognized complications. Radiotherapy in therapeutic doses can produce devascularization and weakening of bone. Radical neck dissection results in altered mechanics of the shoulder girdle and a disruption of normally balanced forces acting on the clavicle. An unusual case of clavicle fracture which is considered to have resulted from an interaction of the effects of these therapies is discussed. An approach for recognizing and distinguishing this entity by its time course, and radiographic and nuclide bone scan appearance is presented.

Adult↗
PubMed1989

Bilateral radical neck dissection: report of results in 55 patients.

Between 1952 and 1982, 55 patients underwent bilateral radical neck dissections at the National Cancer Institute. Of these, 17 patients had simultaneous (one-stage) bilateral dissections and 38 had nonsimultaneous (two-stage) dissections. In 37 patients both internal jugular veins were removed, while one vein was preserved in 18 patients. The operative mortality was 11.8% (2/17 patients) for simultaneous bilateral neck dissections and 2.6% (1/38 patients) for nonsimultaneous staged dissections. The overall operative mortality was 5.4%. Of the 18 patients in whom one jugular vein was preserved, six patients (33%) had postoperative facial edema and swelling, while of the 37 patients in which neither jugular vein was saved, 20 patients (54%) developed significant postoperative facial edema. The overall 2-year recurrence rate was 50%. The overall survival rates were 55% at 3 years and 39% at 5 years.

Adolescent↗
PubMed1982

Synchronous bilateral neck dissection.

The type of treatment used to control evident or possible metastatic cancer in the cervical region remains in dispute. When clinically positive lymph nodes are present in both sides of the neck, treatment to both sides is mandatory. If surgery is elected as the primary treatment, the neck dissection can be done bilaterally, either in one or two stages. Synchronous bilateral radical neck dissection has been associated with a high morbidity rate. It was the purpose of this paper to report the indications, complications, and results in a series of 179 synchronous bilateral neck dissections done between 1967 and 1979. In all except one instance, the internal jugular vein was saved on one or both sides. The mortality rate was 3.4 percent. Patients with histologically positive lymph nodes that were present bilaterally were found to have a reasonable prospect for cure. The rate of recurrence was related more to the inability to control the primary cancer than to treatment failure in the neck.

Carcinoma↗
PubMed1977

[The neck after radical neck-dissection. A follow-up study (author's transl)].

In 200 patients with uni- or bilateral neck dissections the long range cosmetic results, subjective complaints, and the neurologic status were studied at postoperative time intervals between 3 months and 10 years. The main disorders were related to both the absence of resected, tumor-involved structures and to hyperesthesia of the lateral neck skin. The function of the muscle portions of the shoulder was less disturbed than expected, and recovered with some time and training. Cases with bilateral neck dissections showed postoperative edema of the head, being resorbed, with a little persisting submental edema. Postoperative irradiation gave rise to an increasing number of neuralgiform symptoms.

Arm↗