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PubMedDate not supplied

Role of modern imaging in decision-making for elective neck dissection.

This study examines patterns of early metastatic spread as recorded in 19 clinically negative, histologically positive (occult) neck dissection specimens. Microscopic metastatic deposits were detected in this study in nodes measuring 10 mm and less. No nodes with extension of tumor beyond the capsule and into adjacent structures were noted. Central necrosis was detected in only one node. We suggest that the first stages of metastatic disease as evaluated by the pathologist in clinically occult nodes are minimal and may easily evade the eyes of both pathologists and radiologists. Imaging proved to be efficacious in upstaging clinically occult necks that were previously irradiated.

Head and Neck Neoplasms↗
PubMed1990

The use of combination cervical plexus block and general anesthesia for radical neck dissection in a patient with severe chronic obstructive pulmonary disease.

Patients with severe chronic obstructive pulmonary disease (COPD) who receive a general anesthetic are at increased risk for postoperative pulmonary complications; therefore, it is desirable to avoid or to limit the dose of general anesthesia in these patients. Regional anesthesia, or a combination of regional and light general anesthesia, is an ideal choice for achieving this goal. This case report demonstrates how we used cervical plexus blocks in combination with light levels of general anesthesia for radical neck dissection in a patient with severe COPD.

Aged↗
PubMed1993

[The role of elective neck dissection in the surgical treatment of supraglottic carcinoma].

The survival rates of 622 operative cases with supraglottic carcinoma from October, 1977 to October, 1990 treated in The First Hospital of CMU were compared. The 3.5 and 10 year survival rates were 79.48%, 72.53% and 65.22% respectively. With regard to different surgical procedures, the 3.5 and 10 year-survival rates of END was 94.54%, 91.29% and 86.60% respectively; those of CND were 55.79%, 42.39% and 31.17%; and of NND, 79.15%, 74.53% and 68.56%. There were significant differences between either two groups. The authors suggest that elective neck dissection has an important role in surgical treatment of patients with supraglottic carcinoma.

Adult↗
PubMedDate not supplied

Neck dissection for thyroid cancer.

Decisions concerning the extent of surgical treatment for thyroid cancer remain controversial. Limited surgical procedures, designed to remove only the cancer that is clinically evident, can be successful since the primary determinants in survival are age, sex, and histologic type rather than number of positive nodes or other factors. A retrospective review of 339 patients who had surgical procedures for cancer of the thyroid at MDA hospital from 1975 to mid-1989 did not show a conclusive advantage for any type of neck dissection. The operations were tailor-made to include all evident clinical cancer. Secondary procedures, such as surgery, radioactive iodine, radiation therapy were successful in treating recurrences, which occurred in all surgical groups, whether limited or radical.

Adolescent↗
PubMed1988

Patency of the internal jugular vein after functional neck dissection.

The objective of this study was to determine the immediate patency rate for internal jugular veins preserved in functional neck dissections. Thirteen patients had contrast-enhanced CT scans 2 to 4 weeks postoperatively. Ten veins were patent and had a diameter comparable to that seen on the preoperative scan; one vein was narrowed but patent; two were occluded. Probable factors associated with occlusion include trauma of the vessel and extrinsic compression of the vein by the skin or myocutaneous flaps.

Head and Neck Neoplasms↗
PubMed2006

Split therapy: planned neck dissection followed by definitive radiotherapy for a T1, T2 pharyngolaryngeal primary cancer with operable N2, N3 nodal metastases--a prospective study.

BACKGROUND: The management of patients with a small pharyngolaryngeal cancer (T1 and T2) with large nodal metastases is a subject of debate. We present data on the feasibility and outcome of treating these patients with surgery for the nodal metastases followed by definitive radiotherapy. METHODS: Prospective study of 59 patients of small pharyngolaryngeal primary squamous carcinomas with operable (N2/N3) nodal metastasis treated with neck dissection followed by radiotherapy. RESULTS: Complete nodal clearance was achieved in 54 (90%). The mean nodal size was 4 cm and extranodal extension was seen in 88% of patients in the study group. There were no significant postoperative complications. Median interval between surgery and radiotherapy was 23 days. Forty-nine patients (83%) started their RT within 6 weeks of surgery. With a median follow-up of 25 months, the disease free and overall survival was 54% and 60% (5 years). CONCLUSION: The management of patients with a radiocurable pharyngolaryngeal primary with large nodes by this approach is a feasible option with adequate control and survival.

Adult↗
PubMed2006

Prevalence and localization of nodal metastases in squamous cell carcinoma of the oral cavity: role and extension of neck dissection.

Lymph node (LN) metastases represent the most important negative prognostic factor in squamous cell carcinoma (SCC) of the oral cavity, even though controversies still exist regarding their management. The aim of this study was to retrospectively analyze our experience in surgical management of SCC of the oral cavity with particular focus on the prevalence and localization of lymph nodal metastases and recurrences. The clinical records of 89 consecutive patients treated from 1983 to 2002 by concomitant surgery on both the T and N sites, excluding those undergoing salvage surgery, were reviewed. A total of 119 neck dissections (ND) were performed. Survival outcomes were calculated by the Kaplan-Meier method, while univariate comparisons by the log-rank and non-parametric tests were performed between different groups of patients. Five-year overall and determinate survivals were 50 and 57%, respectively. LN metastases were observed in 52% (56% of these showing extracapsular spread) and their presence strongly correlated with determinate survival (p < 0.0001). The prevalence of clinical and occult nodal disease was not related to the pT status. Neck levels II (59%) and I (56%) were most frequently involved. Metastases to level IV accounted for 15% of positive LN, even though 28% of them turned out to be skip metastases. Five neck recurrences were observed, only one of which was salvaged by surgery. The high prevalence of clinical and occult LN metastases in this setting suggests that ND should be performed on a nearly routine basis, even for lesions with a low-T category and a cN0 neck. Moreover, ND should always encompass level IV due to the possibility of skip metastases, particularly in tumors involving the oral tongue. In patients with a cN+ neck, levels from I to V should be addressed, particularly in the presence of metastases at levels III and IV.

Adolescent↗
PubMedDate not supplied

[Prognostic value of the number of involved nodes after neck dissection in oropharyngeal and oral cavity carcinoma].

PURPOSE: To evaluate the relationship between the number of positive nodes and probabilities of locoregional control and survival in patients with invasive squamous cell carcinomas of the oral cavity and oropharynx. MATERIAL AND METHODS: Between 1976 and 1993, we treated with curative intent 183 patients (median age: 56 years; standard deviation: 10 years). Seventy-nine patients (43%) had oropharyngeal primary invasive carcinoma and 104 (57%) had oral cavity (excluding the lip) primary invasive carcinoma. Patients with simultaneous primary lesion or visceral metastases were excluded from the analysis. All the patients had neck dissection with at least six nodes to analyse. One-hundred fifty-nine patients (87%) underwent resection of the primary lesion and 158 (86%) were treated postoperatively with external beam irradiation alone or combined with interstitial implant (median dose: 60 Gy; standard deviation: 10 Gy). Average follow-up was 52 months. RESULTS: The overall 5-year survival rate using the Kaplan-Meier method was 42.6%. The 5-year survival rates were 60.0% when lymph nodes were histologically negative, 39.5% when one lymph node was positive, 28.0% when two lymph nodes were positive and 24.4% when three or more lymph nodes were positive (P = 0.0004). The number of positive nodes did not significantly influence the specific disease-free survival and locoregional control rates. CONCLUSION: Patients with one or more positive neck nodes must have postoperative treatment.

Adult↗
PubMedDate not supplied

[Postoperative complications in patients with functional neck dissection].

The aim of this study was to assess the complications of surgical treatment of patients with laryngeal cancer undergoing functional neck dissection (FND). Local and medical complications, post-operative sequelae, post-operative stay and fatality rate were recorded in 195 patients. Overall complication rate was 43.07%, with 45 wound infections; 35 wound dehiscences; 39 serohematomas; 4 chylous fistulae; and 11 hemorrhages (2 cases of internal jugular vein rupture). Medical complications were seen in 11 patients. The significant association of pharyngocutaneous fistula with wound infection and dehiscence raises a reasonable doubt about the relative participation of FND in the reported complication rate. Overall incidence of surgical fatality as a result of complications was 2.56% (5/195). Permanent sequelae were found in 4.24% of FNDs (11/259). The average hospitalization was 25.17 +/- 19.88 days. Although an accurate evaluation of intrinsic complications of FND is difficult to perform in patients with combined single-state surgery for the tumor and the neck, most complications of FND are local and easy to manage.

Adult↗
PubMed1995

The ultimate modification in the modified neck dissection.

PURPOSE: A study was undertaken to study the potential benefits for function and regional recurrence of preserving the sensory ventral branches of the cervical plexus in modified neck dissections. METHODS: Fifteen cases of squamous cell carcinoma or melanoma of the head and neck in which the sensory nerves were spared were matched to 15 cases in which the nerves were sacrificed. The subjects were examined for sensory loss, questioned regarding acute and chronic dysfunction, and followed for regional recurrence for a minimum of 2 years. RESULTS: The group whose nerves were preserved had significantly less sensory loss and a lower incidence of acute and chronic dysfunction. No subjects in either group had regional recurrence. CONCLUSION: The results of this initial study support a policy of routine preservation of the sensory ventral branches of the cervical plexus when there is no direct tumor involvement.

Carcinoma, Squamous Cell↗
PubMed2000

Ipsilateral neck cancer recurrences after elective supraomohyoid neck dissection.

DESIGN: Retrospective analysis of a case series. SETTING: Referral center, private or institutional practice, hospitalized care. OBJECTIVE: To analyze the level (site) of ipsilateral neck recurrences after supraomohyoid (SOH) dissection in patients with lip, oral, and oropharyngeal cancer treated in a single institution. INTERVENTION: Supraomohyoid neck dissection. PATIENTS AND METHODS: From 1979 to 1997, 154 patients with oral and oropharyngeal carcinoma and no palpable lymph nodes at the neck underwent ipsilateral elective SOH dissection. RESULTS: Tumor sites were the lip, 5 cases (3.3%); oral cavity, 128 cases (83.1%); and oropharynx, 21 cases (13.6%). Tumor stages were T1, 13 cases (8.4%); T2, 77 cases (50.0%); T3, 40 cases (27.0%); and T4, 22 cases (14.3%). There were 7 cases (4.5%) of ipsilateral neck recurrences. Three were beyond the limits of the SOH dissection, and 4 were inside these limits. There was no association of neck recurrences with the pathological status of the lymph nodes. Six of the 7 recurrences were in patients who underwent postoperative radiotherapy. CONCLUSIONS: The incidence of neck recurrence after selective neck dissection was 4.5%, and it occurred either inside (57.1%) or beyond (42.9%) the limits of the selective neck dissection.

Adult↗