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PubMed2005

Complex head and neck specimens and neck dissections. How to handle them.

Dissecting surgical specimens from the upper aerodigestive tract is often difficult because of their complicated anatomy. The local environment dictates the routes of tumour spread and surgical margins at risk, and these features differ for various subsites within this part of the body. The examination of surgical specimens of the upper aerodigestive tract should disclose whether postoperative adjuvant treatment is needed and allow the evaluation of preoperatively performed diagnostic imaging. The aim of this article is to provide a concise guideline for the dissection of specimens from this part of the body.

Dissection↗
PubMed1985

Neck dissection for cancer.

Control of metastatic disease in the neck is only a part of the spectrum of treatment of a patient with head and neck cancer. Concepts as to how to manage both the primary cancer and the possible metastases in the neck are constantly changing, and new combinations are being proposed almost daily. This article focuses mainly on the various surgical procedures that have been advocated in an attempt at controlling metastatic disease in the neck. The author has not considered the role of control of the primary cancer nor the significance of distant metastases in the rate of survival of patients with head and neck cancer. The frequency with which patients with cancer of the upper aerodigestive system develop second primaries indicates that we are only dealing with a portion of the problem. We have no way of reversing the premalignant changes that have probably developed in the epithelial surface of the smokers/alcoholics who constitute such a large percentage of the patients with whom we deal.

Adenocarcinoma↗
PubMed1995

Transoral laser resection with staged discontinuous neck dissection for oral cavity and oropharynx squamous cell carcinoma.

Transoral laser resection of oral cavity and oropharynx squamous cell carcinoma (OOSCC) is a widely accepted approach in the absence of cervical lymph node metastases. This study investigated the results of transoral laser surgery and discontinuous neck dissection (ND) for OOSCC with clinically obvious or suspected cervical node metastases. One hundred seventeen patients with infiltrating oral carcinoma were treated for cure with transoral resection of the primary and staged ND. Twenty-nine primaries were classified as T1, 50 as T2, 35 as T3, and 3 as T4. Lymph node metastases were identified in the ND specimen of 36 patients. All patients were followed for a minimum of 3 years unless they died. Estimated tumor-related survival after 5 years is 81% for stage I and II disease of the oral cavity, 86% for stage I and II disease of the oropharynx, 73% for stage III disease of the oral cavity, 65% for stage III disease of the oropharynx, and 21% for stage IV disease of the oral cavity and the oropharynx. Local and regional control of cancer was achieved in 72 (62%) of the 117 patients. Forty-five local and regional recurrences were diagnosed during the follow-up period. Two patients died of distant metastases with no evidence of local or regional recurrence. The combination of transoral laser resection and staged ND for the treatment of OOSCC seems to offer satisfactory cure rates for a selected group of patients. These two minor surgical interventions cause less morbidity than commando-type surgery and lead to low perioperative mortality and morbidity.

Adult↗
PubMed1985

Modified neck dissection for metastatic testicular carcinoma.

Carcinoma of the testicle is a unique clinicopathologic entity in that an optimistic attitude toward cure can be entertained even in the presence of distant metastasis. Chemotherapy, followed by an aggressive surgical resection of residual disease, can result in eradication of this neoplasm. This tumor is capable of being monitored by the use of serum markers, namely, human chorionic gonadotropin and alpha-fetoprotein. After induction chemotherapy, the transition of elevated serum tumor markers to normal levels suggests that malignant disease has been eliminated or converted to teratoma. Elevated markers indicate persistent or recurrent carcinoma and mandate further chemotherapy. If normalization of tumor markers occurs, any residual mass in the abdomen, chest, or neck should be surgically resected. The otolaryngologist plays a role in the diagnosis and the resection of residual neck disease. Metastatic testicular carcinoma can present as a supraclavicular neck mass and must be considered in the differential diagnosis of a mass in this area. Large residual neck lesions are best removed through the exposure afforded by modified neck dissection.

Adolescent↗
PubMed1997

Modified neck dissection in the treatment of differentiated thyroid carcinoma.

The prognosis of differentiated carcinoma of the thyroid has been reported to be extremely favourable. Previous studies have concluded that lymph node metastasis do not affect survival rates in patients with differentiated thyroid carcinoma. Therefore, nodal metastasis has not been evaluated as a prognostic factor in recent definitions of risk groups. To determine the significance of nodal disease, we reviewed 219 consecutive patients with differentiated thyroid cancer (191 papillary, 14 follicular and 14 Hurtle cell carcinomas). Fifty-five patients were treated with modified neck dissection and all of them received adjuvant radioiodine. There were recurrences in 25 patients (11.4%), with follow-up ranging from 6 months to 14 years. Systemic disease occurred synchronously in two patients, and four patients died of thyroid carcinoma.

Adenocarcinoma↗