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PubMed2005

Neck dissection followed by radiotherapy or chemoradiotherapy for small primary oropharynx carcinoma with cervical metastasis.

OBJECTIVES: A cohort of patients with small primary (T1-T2) squamous cell carcinoma of the oropharynx and advanced cervical nodal metastasis were treated with initial neck dissection(s) followed by definitive radiation therapy with or without chemotherapy. Our rationale for this algorithm and our results are examined. STUDY DESIGN: Retrospective chart review. METHODS: Pathology records and medical records from 1996 to 2003 from the Johns Hopkins Hospital were examined for patients meeting the inclusion criteria. RESULTS: Sixteen patients meeting the inclusion criteria were identified. Follow-up periods ranged from 6 to 75 months. Mean and median follow-up periods were 38 and 33 months, respectively. One (6.25%) patient developed a metastasis and was alive with disease at last follow-up. Fifteen (93.75%) patients were alive without evidence of disease at last follow-up. Overall survival was 100%. Disease free survival was 93.75%. CONCLUSION: Initial neck dissection followed by primary radiation therapy to the primary site and neck with or without chemotherapy is an effective therapy for small primary oropharynx cancers with N2 or greater cervical metastases.

Adult↗
PubMed1987

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) following neck dissection.

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is characterized by hyponatremia and urinary osmolality generally greater than serum osmolality. It is due to inappropriate water retention resulting from excessive release of antidiuretic hormone (ADH). Seventeen patients undergoing neck dissection were studied. Six developed SIADH and two became symptomatic due to profound hyponatremia. Five of the six patients who developed SIADH had previously undergone a neck dissection and/or had received radiation therapy. A suggested pathophysiologic mechanism for this phenomenon is discussed. The syndrome can usually be prevented by fluid restriction during and after surgery.

Aged↗
PubMed2002

Evaluation of factors concerning the patency of the internal jugular vein after functional neck dissection.

The aim of this study was to evaluate the effects of several factors on the patency of the internal jugular vein (IJV) after functional neck dissection (FND). A prospective clinical study was undertaken in 21 patients (36 neck dissections) before and after FND at the 1st and 3rd postoperative months by using duplex Doppler ultrasonography. The patients who had radiation therapy (RT) were evaluated again in the 6th postoperative month in order to assess possible late effects of radiation therapy. In our patients the patency rate was 100%, and no thrombosis was found. But the area at rest and during Valsalva's maneuver was reduced, and this difference was found to be statistically significant. It was concluded that the patency of the IJV remains normal after FND. Radiation therapy, infection or fistula formation have no detrimental effects on patency. In addition, the number of ligated branches do not seem to be related to the patency rate.

Aged↗
PubMedDate not supplied

Occurrence, duration and prognosis of unexpected accessory nerve paresis in radical neck dissection.

Injuries to the spinal accessory nerve in connection with radical neck dissection occur frequently, despite the preservation of the nerve. Although the surgeon was unaware of any serious lesion of the accessory nerve, a trapezius paresis of varying degree was observed in about 60% of the patients during convalescence. The shoulder function improved in most patients, but major paresis with loss of essential rotary and supportive functions of the trapezius muscle persisted in 17% of the patients operated on. No further improvement was seen 18 months after the surgical trauma.

Accessory Nerve Injuries↗
PubMed2001

Venous collateral blood flow assessed by Doppler ultrasound after unilateral radical neck dissection.

Removal of the internal jugular vein (IJV) in unilateral radical neck dissection (rND) necessitates redirection of cerebrovenous blood to collateral pathways. If adaptation is insufficient, neurologic sequelae develop that are due to impaired venous drainage and increased intracranial pressure. The authors studied venous hemodynamic effects of unilateral rND using Doppler and duplex ultrasound in 17 patients. Blood flow velocities (BFVs) were recorded from the distal IJV (dIJV) and the vertebral vein (VV) before and 9 to 88 days after surgery. A preoperative compression test of the dIJV was performed to identify the side of dominant drainage. The BFV increased in the contralateral dIJV after right-sided rND (n = 10) by 111% (range, 50% to 320%), and after left-sided rND (n = 7) by 34% (range, 5% to 105%). In the contralateral VV, a rise of BFV by 75% was found. Our results confirm the role of the contralateral dIJV as the predominant collateral pathway. The VVs serve as an important additional major outflow. Doppler ultrasound may help to identify patients at risk of insufficient cerebrovenous drainage after rND.

Blood Flow Velocity↗
PubMed1980

The irradiated radical neck dissection in squamous carcinoma: a clinico-pathological study.

A preliminary clinico-pathological survey is presented of radical neck dissections from 50 patients with advanced (T3, T4) squamous carcinomas of the head and neck, previously treated by irradiation and combination chemotherapy. The total yield of lymph nodes (1411) from these dissections was high--mean of 28 nodes/dissection, range 8-60; the proportion of nodes containing metastatic carcinoma was low--100 (7%)--with only 1 or 2 nodal masses/dissection in most instances. The involved nodes tended to be concentrated in 1 or 2 anatomical groups, principally in the upper anterior neck, with apparent sparing of nodes in the posterior triangle. There was a high incidence (88%) of transcapsular spread. Keratin granulomas, with or without intact metastatic carcinoma, were commonly found; on occasions they formed large masses simulating nodal metastases. The morphological patterns in uninvolved lymph nodes were shown to be of no prognostic significance. Initial data on postoperative follow-up indicated a crude survival of 52% (24 patients) at 30 months. Most deaths (80%) occurred within 12 months of major surgery; the majority (72%) died with residual malignant disease; and uncontrolled primary tumour, particularly in the oral cavity and oropharynx, was found more frequently than metastatic disease in the neck or elsewhere. Clinical implications are discussed with reference to the use of modified radical neck dissection in the surgical salvage of this poor-risk group of previously irradiated patients.

Adult↗
PubMed1993

[Regional lymph node recurrence in patients with papillary thyroid carcinoma who did not undergo neck dissection].

It is important and difficult problem to manage patients with thyroid nodules which are indeterminate as papillary thyroid carcinoma (PTC) before surgery and identified as PTC after surgery. This paper highlighted whether immediate reoperation for such patients should be undergone or not. The prognosis of 196 patients with PTC who underwent lobectomy or subtotal thyroidectomy without neck dissection were studied (non-dissection group). The controls consisted of 783 patients with non-advanced PTC who underwent radical surgery during the same period (dissection group). There was no death due to PTC in both groups. Distant metastasis was observed 1.5% in non-dissection group and 2.2% in the dissection group. Local recurrence was observed 9.7% in the non-dissection group and 11.2% in the dissection group. The results suggested that immediate reoperation for the patient's who did not undergo neck dissection, is not necessary. It is thought that all of lymph node metastasis detected only by histology does not always behave in same.

Adult↗
PubMed2003

Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection.

OBJECTIVE: To determine the frequency and pattern of lymph node metastasis (LNM) from papillary thyroid microcarcinoma (PTMC) and the results of node dissection, and to establish the optimal strategy for neck dissection in these patients. SUMMARY BACKGROUND DATA: Most PTMCs carry a favorable prognosis, but a few present with palpable lymphadenopathy. Patients with LNM are at risk for nodal recurrence, although they do not have higher mortality. The frequency and pattern of LNM from PTMC and the results of node dissection are not well established. METHODS: The frequency and pattern of LNM from 259 PTMCs were analyzed according to the size and location of the primary tumor. Of the 259, 24 with palpable nodes underwent therapeutic node dissection and the other 235 patients without palpable nodes underwent prophylactic node dissection. The authors compared the results of node dissection between the therapeutic group and the prophylactic group, and between PTMCs 5 mm or smaller and PTMCs larger than 5 mm. The authors also compared nodal recurrence between the prophylactic group and a no-lymph-node-dissection group (155 PTMCs). RESULTS: Overall, 64.1% (166/259) and 44.5% (93/209) had node involvement of the central and ipsilateral lateral compartment, respectively. Pretracheal (43.2%), ipsilateral central (36.3%), and ipsilateral mid-lower (37.8%) jugular were more commonly involved. LNM was more frequent in the therapeutic group than in the prophylactic group (95.8% vs. 60.9% for central compartment, 83.3% vs. 39.5% for ipsilateral lateral compartment). Nodal recurrence was more common in the therapeutic group than in the prophylactic group (16.7% vs. 0.43%), but did not differ between the prophylactic group and the no-dissection group (0.43% vs. 0.65%). The tumor size did not influence nodal recurrence. Nodal recurrence preferentially occurred in ipsilateral mid-lower jugular nodes. CONCLUSIONS: Patients who have PTMC presenting with palpable lymphadenopathy should have therapeutic node dissection. Prophylactic node dissection is not beneficial in those without palpable lymphadenopathy.

Adolescent↗
PubMed2001

A case of rupture of the internal jugular vein caused by postoperative infection of functional neck dissection.

A 68-year old diabetic man with gingival cancer of the lower jaw underwent resection of the mandible and functional neck dissection. Swabs of a postoperative wound infection revealed methicillin-resistant Staphylococcus aureus (MRSA). The wound was irrigated, and antibiotics administered. The pathogens isolated were sensitive to the antibiotics used, but the infection failed to respond to treatment. Bleeding ensued on the 14th postoperative day (#14POD), when the wound was opened to reveal thrombosis and rupture of the right internal jugular vein. The patient's condition improved after ligation and surgical debridement of the right internal jugular vein. Our experience underlines the importance of early radiological investigation for possible thrombus formation in the internal jugular vein in cases of postoperative wound infection follows functional neck dissection with conservation of the internal jugular vein. It is also important to actively treat this condition surgically, including ligation of internal jugular vein for suppressing inflammation.

Aged↗
PubMed1998

[Prevention and management of chylous fistula after neck dissection].

OBJECTIVE: To evaluate the effect of treatment for chylous fistulas after neck dissection, as a means of reasonable option of therapeutic measures. METHODS: Of 37 chylous fistulas, 30 were left-sided and 7 were right-sided. Conservative therapy which included closed-wound drainage and local pressure dressing and/or low-fat nutritional support was employed in 26 cases, and 50% glucose was injected into the neck basic wound bed in 2 cases, to promoto the chylous fistula healing up. Operative ligation was performed in 7 cases. Open-wound and packing in 4 cases. RESULTS: Eighty-six percent chylous fistula occured from 1 to 3 postoperative days. Of 26 chylous fistulas with conservative management, 15 cases were successfully treated, the mean duration for healing was 9.7 (4-30) days, the remaining 11 cases failed to had and were further treated surgically. Seven cases with operative ligation were successful, and the other 4 cases with open-wound and packing had delayed healing, the mean duration was 8.5 (7-10) days. CONCLUSION: The majority of patients with chylous fistulas could be treated reasonablly without increasing the hospital days. The conservative therapy should be employed in cases with a maximal production of chyle below 500 ml a day. Operative ligation should be done early in cases with a maximal production exceeding 500 ml a day and with conservative treatment failure for a few days. The open-wound and packing should be used in chylous fistulas persisting for more then 7 days.

Adolescent↗
PubMed2005

[Efficacy of radical neck dissection for advanced cervical nodal metastases].

OBJECTIVE: To investigate the efficacy of radical neck dissection (RND) to control advanced cervical nodal metastases and analyze the risk factors related with cervical recurrence in head and neck cancer. METHODS: One hundred and twelve patients with N2, N3 head and neck cancer were treated by RND were retrospectively reviewed and the pathological specimen were restudied. RESULTS: Five-year cervical recurrence rate of patients with advanced nodal metastases after RND is 27.7% (31/112), and 16.5% (13/79), 54.5% (18/33) in N2, N3 respectively. The overall 3-year, 5-year survival rate of patients with cervical recurrence after RND was 16.1% (5/31), 9.7% (3/31) respectively. In a univariate chi2 analysis, it was confirmed that the following variables correlated to cervical recurrence, i. e., clinical N staging, size of positive neck nodes, presence of extracapsular nodal spread and invasion of nonlymphatic structures. In a multivariate logistic regression analysis, the most significant risk factor for cervical recurrence was the size of positive neck nodes. CONCLUSIONS: Cervical recurrence is one of the most common reasons for tumor recurrence of head and neck cancer. The size of positive neck nodes is the key risk factor in determining the development of cervical recurrence in patients of advanced cervical nodal metastases after RND. Patients with presence of extracapsular nodal spread and invasion of nonlymphatic structures have high risk of developing cervical recurrence.

Adult↗
PubMed1996

Severe cervical chyle fistula after radical neck dissection.

The case of a chylous cervical fistula detected immediately after radical neck dissection is presented. The flow and metabolic derangements secondary to depletion of fluid, electrolytes, and protein required the ligation of the thoracic duct at the thoracic cavity. The various possible treatments of chylous fistula are reviewed.

Blood Proteins↗
PubMed1989

Dyspnea resulting from accumulation of pleural effusion after radical neck dissection. A case report.

The patient became dyspneic 3 days after radical neck dissection on the left side. A chest radiography showed bilateral pleural effusion.During the operation, a lymphatic leak was noted. In this case, the factor of an associated perforation of the pleural had not been demonstrated. Fresh frozen plasma was administered and positive end-expiratory pressure was applied. The patient had no residual pulmonary sequelae.

Blood Transfusion↗