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PubMed1953

Treatment of intraoral carcinoma; combined resection of the jaw and radical dissection of the neck.

Intraoral carcinomas first occur as primary growths. From these sites they spread by the lymphatics to the regional nodes. In the past, treatment of these lesions has consisted of radiation therapy for the primary lesion, followed by radical neck dissection. The results of this treatment have not been satisfactory. On the other hand, for carcinoma elsewhere in the body the results of surgical extirpation of the primary lesion, of the intervening lymphatics and of the regional nodes at the same operation has given much better results. In the past few years an attempt has been made to improve the results of treatment of intraoral carcinoma by removal in continuity of the primary lesion, intervening lymphatics and regional nodes. The improvement in anesthesiology, electrolytes and fluid balance, blood replacement, and the development of the antibiotics, in conjunction with the realization that the cosmetic deformity is not as great as might be expected, has led to this development. In those centers where it has been possible to apply this principle of treatment to intraoral carcinoma the results have been very encouraging.

Carcinoma↗
PubMed1993

Posterior triangle metastases of squamous cell carcinoma of the upper aerodigestive tract.

The trend toward function-conserving surgery in the treatment of squamous cell carcinoma of the head and neck has led to a progression from radical neck dissection to modified neck dissection and selective neck dissection has growing support. These surgical modifications have resulted from an effort to spare structures uninvolved with malignancy. Level V dissection can be associated with spinal accessory dysfunction in some patients even when the nerve remains intact. In this study, we have attempted to address the need for level V dissection by determining the prevalence of level V metastases in a large series of patients undergoing radical neck dissection. There were 1,123 patients who underwent 1,277 neck dissections between 1965 and 1986. A review of pathologic and clinical records revealed 40 patients (3%) with positive nodes at level V. The prevalence of level V metastases was greatest with hypopharynx and oropharynx primary tumors (7% and 6%, respectively). Level V metastases were found in 1% of patients with oral cancers and 2% of those with larynx cancers. Groups were divided into N0 (282), N+ (719), and subsequent N+ (276), depending on the clinical status at the time of surgery. Thirty-seven of 40 patients with posterior triangle metastases were clinically N+. The prevalence of metastases at level V was 1% for N0, 5% for N+, and 0% for subsequent N+. This large series shows minimal involvement of metastases at level V. The low likelihood of metastases at level V, even in N+ disease, should be considered when performing lymphadenectomy for squamous cell carcinoma of the upper aerodigestive tract.

Carcinoma, Squamous Cell↗
PubMed2005

Management of the patients with hypopharyngeal cancer: eight-year experience of Miyagi Cancer Center in Japan.

The aim of this study is to evaluate the results of treatment for hypopharyngeal cancer and indicate the future prospect of the treatment. Seventy-four patients with squamous cell carcinoma of the hypopharynx admitted to Miyagi Cancer Center from 1993 through 2000 are reviewed. Sixty-four patients received radical treatment, and 10 patients received palliative treatment or no treatment. The cancer was advanced (stages III and IV) in 82% of all the patients. The overall 5-year survival rate of all the patients was 38%. The overall 5-year survival rate of 64 patients received radical treatment was 43%. The ten patients who received palliative treatment or no treatment died of cancer within 16 months. Fifty-two out of the 74 patients underwent neck dissection for the neck lymph node involvement; forty of the 52 patients underwent ipsilateral neck dissection and 12 underwent bilateral neck dissection. Four out of the 40 patients, who underwent ipsilateral neck dissection alone, developed late contralateral regional recurrence but were successfully treated by contralateral neck dissection at the time of recurrence. Twenty-three out of 74 patients had multiple primary cancers synchronously or metachronously (31%). Cause of the death of six patients out of 74 patients was confirmed to be primary cancers other than hypopharyngeal cancer, as judged by physicians in other department or other hospitals. Most of the patients died due to distant metastasis from hypopharyngeal cancer or other primary cancers. We therefore conclude that contralateral elective neck dissection which is frequently chosen for the treatment of hypopharyngeal cancer surgery is unnecessary. Even if locoregional control is accomplished, distant metastasis or multiple primary cancers emerge and make prognosis poor. To improve the prognosis, we should develop some strategy against hypopharyngeal cancer for each patient. New strategies including chemoprevention and surgery against distant metasistasis are necessary.

Carcinoma, Squamous Cell↗
PubMed1993

The management of the clinically positive neck as part of a larynx preservation approach.

PURPOSE: For patients with squamous cell carcinoma of the head and neck with palpable neck node metastases, the standard management of the neck usually involves neck dissection and postoperative neck irradiation. A strategy of larynx preservation with induction chemotherapy and radiation therapy has been utilized for patients with locally advanced resectable cancer of the larynx, hypopharynx, and oropharynx. For patients treated in this non-surgical manner for the primary site, the optimal management of the clinically positive neck has not been clarified. To determine whether response to induction chemotherapy could help to select patients in whom neck dissection could be omitted in favor of definitive radiation therapy alone, we have analyzed our prospective larynx preservation experience. METHOD AND MATERIALS: Between 1983-1989, 80 patients were entered onto larynx preservation protocols involving 1-3 cycles of cisplatin based chemotherapy followed by radiation therapy with or without neck dissection. There were 54 patients with clinically positive necks to treatment, of whom 44% (24/54) had a complete response, and of whom 20% (11/54) had a partial response to chemotherapy in the neck. In 22 of these 35 patients with clinically positive necks who achieved a major neck response to chemotherapy, radiation therapy (median 66 Gy) was used as the only subsequent treatment of the neck. RESULTS: At a median follow-up of 25 months (range 7-83 months), neck control for this subset is 91% (20/22). Neck failure occurred in 20% (1/5) of patients with a partial response to chemotherapy treated without neck dissection and 6% (1/17) of node positive with a complete response. CONCLUSION: These results suggest that patients with clinically palpable cervical nodal metastases who have a complete response to chemotherapy and receive high dose radiation therapy have excellent neck control and may not need neck dissection. Further experience will be required to confirm these preliminary data and to determine if patients who achieve a partial response in the neck after induction chemotherapy can be treated with radiation therapy without neck dissection.

Adult↗
PubMed2001

[Surgical treatment of neck lymph nodes in squamous cell carcinoma of the pyriform sinus].

The present study reports the results of 66 patients surgically treated for squamous cell carcinoma of the pyriform sinus between 1984 and 1996. Twenty eight patients underwent mono!ateral neck dissection and bilateral neck dissection was performed in 38 cases, for a total of 104 radical neck dissections. Of these, 73 (71%) were modified type III dissections, 17 (16%) were classical, and 14 (13%) were modified type I and II dissections. The primary lesion was strictly lateralized in 47 cases (71%), while median structures were involved in 19 patients. The primary tumor was staged pT1 in 2 patients, pT2 in 29, pT3 in 19, and pT4 in 16. The overall incidence of lymph node metastases was 79% (9 pN1, 3 pN2a, 33 pN2b, 7 pN2c) which was not correlated with T stage (50% pT1, 72% pT2, 89% pT3, 81% pT4). Occult nodal metastases were present in 42% of cases (8/19) with an incidence that increased from 11% (1/9) for pT1-2 to 70% for pT3-4 (7/10). The bilateral metastases (11%) were uniformly distributed between strictly lateral neoplasms and those tumors involving the midline. The incidence of bilateral metastases reached 19% only in patients with T4 cancers. Occult controlateral metastases were found in 12% of patients not having clinical evidence of metastases on the contro-lateral side of neck dissection (4/33). Nodal metastases never involved the I and V levels. Our data did not permit an assessment of the incidence of retropharyngeal lymph node metastases. In view of these results and considering current knowledge of the anatomy of lymphatic drainage, a selective II-IV dissection extending to the level VI on the side of the tumor appears justified in cases clinically staged as NO. In our view, when the lesion involves the posterior wall of the pharynx, neck dissection should be extended to the lateral retropharyngeal lymph nodes. Selective dissection of the controlateral side of the neck should be performed in patients having either locally advanced primary lesions or with lesions approaching the midline. In the presence of metastases which are either clinically or intraoperatively evident, neck dissection should be extended to additional lymph node levels.

Adult↗
PubMed2005

[Diagnosis and reoperation for thyroid carcinoma].

OBJECTIVE: To analysis the reasons of the reoperation of thyroid neoplasm and the efficiency of the surgery and to explore the diagnosis of thyroid neoplasm in order to choose the rational surgical method. METHODS: Reoperation of thyroid cancers were performed in 128 patients from Oct. 1992 to Oct. 2000. The causes of reoperation were thyroid cancer remnants and persistence of the micro carcinoma The type of reoperation includes: 1. completion of lobectomy and isthmectomy or subtotal thyroidectomy. Radical neck dissection or modified neck dissection were indicated for the neck of lymph node metastasis. 2. completion of lobectomy and isthmectomy and modified neck dissection or selective neck dissection for patient with thyroid micro carcinoma. Preoperative fine needle aspiration (FNA) (10 cases), intra-operative frozen section (FS) (55 cases), FNA and FS (13 cases) were done in 78 patients who first visited our hospital, with pure (solitary) thyroid nodule suspected thyroid carcinoma clinically. The results of the above examinations were compared with postoperative pathological results. RESULTS: For the patients with reoperation, the rate of remained cancer was 68.8% (88/128) which was confirmed by pathological results. The occurring of complication was 23.4% (30/128). Laryngeal recurrent nerve paralysis was accounted for 2. 3% and transient postoperative hypocalcemia occurred in 19.5%. Five patients developed local recurrence and 3 had neck metastasis the following up. The 5-, 10-year survival rates of these patients were 92.0% (101/110) and 86.9% (17/20) respectively. The diagnostic accuracy of preoperative FNA, intra-operative FS, FNA and FS were 90.0%, 87.3% and 92.3% respectively. CONCLUSIONS: The rate of postoperative residual carcinoma in thyroid was relatively higher because of misdiagnosis and inadequate operation. It was necessary to take active and reasonable reoperation. Reoperation added to surgical complications. Increasing preoperative diagnostic accuracy & carrying out standard, adequate surgical treatment are the essence to decrease surgical complication.

Adolescent↗
PubMed2002

Primary papillary carcinoma arising in a thyroglossal duct cyst.

We report a case of papillary carcinoma arising in a thyroglossal duct cyst, presenting with an anterior neck mass of a 31-year-old woman. The tumor was judged to be a primary lesion on the basis of intraoperative examination of the thyroid and pathologic findings of the mass. One year later, a small nodular mass in the left thyroid gland and lymph node enlargement of the right cervical lymph node were noted by follow-up imaging studies. Total thyroidectomy, right modified radical neck dissection and central neck dissection were performed. The thyroid gland revealed nodular hyperplasia without evidence of malignancy. On the other hand, the dissected neck lymph nodes revealed metastatic papillary carcinoma. Taken together, these findings suggested the tumor was a primary papillary carcinoma arising in the thyroglossal duct cyst.

Adult↗
PubMed1993

[Surgical treatment of recurrent thyroid carcinoma after primary resection].

Twenty-six patients who underwent the second operation for recurrent thyroid carcinoma were reviewed. 1) Three surgical interventions; dissection of local lymph nodes, modified neck dissection and extended neck dissection, for the patients with recurrent thyroid carcinoma were performed. Among these patients, recurrence of thyroid carcinoma occurred again in 14 (74%) of 19 patients with dissection of local lymph nodes, 15 (63%) of 24 with modified neck dissection, 2 (22%) of 9 with extended neck dissection. Patients with extended neck dissection had significantly less local recurrence than those with other procedures (p < 0.05). 2) Lymph node recurrence on the resected area occurred in 11 (73%) of 14 patients with dissection of local lymph nodes. Ten (67%) of 15 patients with modified neck dissection had recurrence beyond the dissected area. 3) In well differentiated carcinoma, there was recurrence in 5 (62%) of 8 patients with dissection of local lymph nodes, and in 4 (31%) of 13 with modified neck dissection. In contrast, in poorly differentiated carcinoma, we found recurrence in 8 (89%) of 9, and 10 (100%) of 10, respectively. However, in only one (20%) patient with extended neck dissection, recurrence occurred. We conclude that extended neck dissection should be the procedure of choice in patients with recurrent thyroid cancer whenever feasible.

Aged↗
PubMed2005

[Distribution of cervical lymph node metastasis in patients with cN1 supraglottic cancer].

OBJECTIVE: To study the characteristics of the cervical lymph node metastasis of patients with cN1 supraglottic cancer and to elucidate which levels should be involved during neck dissection. METHODS: Modified neck dissections or radical neck dissections were performed for 108 cases (147 sides) of cN1 supraglottic cancer. All the lymph nodes of the samples of 147 operation sides were examined pathologically to identify the metastatic levels. RESULTS: Among samples of 108 cases (147 sides), 126 lymph nodes were metastasis, among which 113 lymph nodes were located in levels II and III (89.7%, 113/126), and 123 lymph nodes in levels II, III and IV (97.6%, 123/126). The 126 metastatic nodes were distributed in the 109 levels and 96 of them were in the levels II and III (88.1%, 96/109) and 106 were in the levels II, III and IV (97.2%, 106/109). Additionally, 45 cases (63 sides) of the 108 patients were pathologically metastasis (41.7%) and bilateral cervical metastasis occurred in 20 cases (18.5%). The cervical recurrent rate was 7.4% (8/108) and occurred in the levels II, III and IV respectively, during five to fourteen years follow-up. CONCLUSION: Levels II, III and IV dissection may be reasonable for patients with cN1 supraglottic carcinomas, levels I and V dissection may be avoidable when pathological evidence of metastasis in levels I and V has not been obtained. Contralateral lymph node dissection at the levels II, III and IV should be performed in the case of ipsilateral pN + or contralateral metastasis cN1.

Adult↗
PubMed1994

Use of decision analysis in planning a management strategy for the stage N0 neck.

OBJECTIVE: There are three major strategies in the treatment of patients with a stage N0 neck with squamous cell cancer of the head and neck: elective neck dissection, elective neck irradiation, and observation. Each has appropriate salvage strategies in the event of local recurrence. We used decision analysis to determine the optimal strategy for neck treatment as a function of the probability of occult cervical metastasis. DATA SOURCES: We used the bibliographies of current articles and books to access clinical studies of patients with stage N0 neck cancer. STUDY SELECTION: Studies that included large numbers of patients and contained a minimum 2-year follow-up, with results analyzed in terms of outcome as a function of stage of neck disease, were included. DATA EXTRACTION: Specific data points were extracted from the studies independently by multiple observers, and mean values were used in the decision analysis. DATA SYNTHESIS: A decision tree was constructed with use of a computer model to compare the three management strategies. Probabilities of each of the possible events depicted in the trees were inserted into the tree structure. These probabilities were gleaned from the literature as described above. A sensitivity analysis was performed to determine the optimal threshold for treatment of the neck. CONCLUSION: A patient with primary squamous cell carcinoma of the head and neck and stage N0 neck status should be observed if the probability of occult cervical metastasis is less than 20%. If the probability is greater than 20%, treatment of the neck is warranted. The treatment plan should ideally involve a single modality of therapy; both neck dissection and radiation therapy are quite efficacious in the clinical context, and the decision of which one to employ should be driven by the treatment of the primary lesion. Decision analysis is useful in complex clinical situations.

Carcinoma, Squamous Cell↗
PubMed1989

Treatment of the clinically negative neck in advanced cancer of the head and neck.

The proper management of the clinically negative neck in primary squamous cell carcinomas of the head and neck remains controversial. Although many clinicians believe that elective neck dissection or neck irradiation are equally effective for controlling subclinical disease, previous studies have not directly addressed this question. The charts of 195 patients with advanced primary squamous carcinoma, yet with clinically negative necks, were reviewed. There were no significant differences in the rates of neck cancer recurrence among the elective neck irradiation, dissection, and combined treatment groups. Elective neck irradiation and neck dissection in patients with clinically negative nodes seemed equivalent in their ability to control neck disease. The decision as to which form of therapy is preferable must therefore be based on other criteria.

Carcinoma, Squamous Cell↗
PubMed2003

The treatment of squamous cell carcinoma of the tonsil with neck node metastases.

BACKGROUND: Patients with tonsillar carcinoma and neck nodes seen at the clinic are not an uncommon occurrence in head and neck practice. Over the years, treatment has ranged from radical jaw neck dissection to radical neck dissection for the nodes and primary radiotherapy to the primary site. Much controversy exists as to which treatment modality yields the best survival. Certainly, surgery to the oropharynx leads to gross morbidity, with problems of swallowing, speech, and cosmesis, although it has been claimed that radiotherapy with neck dissection yields a lower cure rate. METHODS: We investigated a retrospective series of 96 patients all of whom had squamous cell carcinoma of the tonsil and associated lymph node metastases. Of these, 44 primary tumors were treated with surgery and 52 with irradiation. All 44 patients in the surgery group had a radical neck dissection, as did all but 12 in the radiotherapy group. RESULTS: Of the tabulations, patients in good general condition were more likely to receive primary surgery. Overall cause-specific survival for all patients was 69%. Multiple logistic regression revealed no associations; thus, the radiotherapy and surgery groups were well matched. Five-year actuarial survival for those having irradiation was 74%. The five-year survival for the group receiving surgery was 63% (p =.4372). This lack of difference between survival for surgery and radiotherapy was confirmed using Cox's proportional hazards model. CONCLUSION: We conclude that tonsillar carcinoma with lymph nodes can be safely treated by applying appropriate radiotherapy to the tonsillar region and treating the neck with radical surgery, if the disease is more than N1.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Lymph node metastasis in squamous cell carcinoma of the oral cavity: correlation between histologic features and the prevalence of metastasis.

A retrospective study was made of the correlation between preoperative clinical or histologic findings and the prevalence of lymph node metastasis in 60 patients with squamous cell carcinoma of the oral cavity who had histologically confirmed neck metastasis. Of these 60 patients, 39 with clinically N+ necks underwent immediate therapeutic neck dissection, and 21 whose necks were initially N0 but progressed to N+ during observation underwent subsequent therapeutic neck dissection. The primary site, TNM staging, histologic grade of malignancy of biopsy specimen, and location and number of histologically positive lymph nodes were reviewed in each case. The results were as follows: (1) The prevalence of neck metastasis was not significantly correlated with primary site and T stage; however, there was an apparent correlation between histologic grade of malignancy and the prevalence of neck metastasis. Patients with grade I-II histologic malignancy showed limited metastases that involved lymph nodes in levels I-II. On the other hand, patients showing grade III-IV histologic malignancy often had metastases that extended beyond level III, regardless of T stage. These results suggest that histologic grade of malignancy, as well as clinical features, must be taken into consideration when deciding whether supraomohyoid neck dissection is indicated. (2) The group that underwent subsequent neck dissection exhibited less advanced neck metastasis and a better prognosis than the group which underwent immediate neck dissection. These findings show that if they are closely followed up, it is possible to delay neck dissection in N0 patients until a neck metastasis is detected.

Adult↗
PubMed2006

[Operation for well-differentiated invading thyroid carcinoma].

OBJECTIVE: To analyze the surgical data of well-differentiated invading thyroid carcinoma (WITC) , for acquiring the clinical experience. METHODS: A retrospective analysis was made in 201 cases with well-differentiated invading thyroid carcinoma in Liaoning Tumour Hospital from 1984 to 2000. The data were statistically treated for survival curves according to the Kaplan-Meier method. The Log-Rank tests were employed to assess the statistical significance of various groups. RESULTS: There were 3 cases with total laryngectomy and partial cervical trachea resection, 6 cases with partial cervical trachea resection, 67 cases with shaving off tumor from its surface, 9 cases with recurrent laryngeal nerve resection, 26 cases with shaving off tumor from the surface of recurrent laryngeal nerve. Other local structures invaded in 90 cases was resected with the thyroid tumour en bloc. One hundred and eighty nine cases with one thyroid lobe and isthmus ectomy, 5 cases one lobe and opsite subtotal ectomy. One hundred and twenty nine cases simultaneous neck dissection (5 cases bilateral neck dissection), in them, 75 neck radical neck dissection, 59 neck modified dissection. The 5-, 10- and 15-year living rates of well-differentiated thyroid carcinoma patients were 85.6% , 77.3% and 69.4% respectively. Multivariate analysis showed that patients' age, tumour invading structure were independent prognostic factors. CONCLUSIONS: With proper operation, a better cure will be made in WITC.

Adenocarcinoma↗
PubMed2006

[Surgical treatment on primary lesion of advanced pyriform sinus cancer].

OBJECTIVE: To evaluate the efficacy of surgical treatment and combined therapy of advanced pyriform sinus cancer. METHODS: Totally 153 patients with locally advanced pyriform sinus cancer who received surgical treatment in our department from January 1974 to December 1999 were divided into three groups: preoperative radiotherapy with 45.5 Gy followed by surgery (R + S group, n = 125), including 32 laryngeal function sparing surgery; surgery alone (Sa group, n = 13); and surgery followed by postoperative radiotherapy with 56.3 Gy (S + R group, n = 15). Twenty-one patients received piriformectomy, 10 piriformectomy plus partial laryngectomy, and 1 total hypopharyngectomy and pharyngoesophagectomy with laryngeal spared and colon reconstruction. Among 121 patients who did not receive laryngeal function sparing surgery, 13 received near total laryngectomy, 55 total laryngectomy, and 53 total laryngectomy plus total hypopharyngectomy and pharyngoesophagectomy with reconstruction. Eight-six patients received radical neck dissection, 14 modified neck dissection, and 6 lateral neck dissection. Survival rate and laryngeal function sparing rate were analyzed using Kaplan-Meier and COX model respectively. RESULTS: The overall 5-year survival rates were 46.51% in R + S group, 18.33% in Sa group, and 44.44% in S + R group. Laryngeal sparing rate were 13.61% (R + S group), 0 (Sa group), and 0 (S + R group), respectively. R + S group, S + R group and combined therapy group (R + S group plus S + R group) showed superiority over Sa group in teams of 5-year survival rate (P = 0.0364, P = 0.0462, P = 0.000). R + S group showed superiority over S + R group and Sa group in teams of laryngeal sparing rate. Therapy mode was the most important factor that contributed to 5-year survival rate and laryngeal sparing. No significant differences were found in complication rate among the groups. CONCLUSION: Preoperative radiotherapy conduces to preserve laryngeal function of patients with locally advanced pyriform sinus carcinoma.

Adult↗
PubMed1998

Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma.

UNLABELLED: The benefits of prophylactic central neck dissection (PCND) in patients with papillary thyroid carcinoma (PTC) have not been clearly demonstrated so far and should be weighed against the potential risks of the procedure. The aim of the study was to assess the recurrent laryngeal nerve and parathyroid risks of PCND after total thyroidectomy in patients with PTC and to compare the results with those obtained in patients who underwent total thyroidectomy only. METHODS: We selected 100 patients who underwent a total thyroidectomy: 50 for nontoxic benign multinodular goiter (Group 1) and 50 for PTC (Group 2). Patients with PTC had no evidence of macroscopic lymph node invasion during surgery and underwent, in addition to the total thyroidectomy, a PCND. All of the 100 patients were operated on by two experienced endocrine surgeons. All patients had pre- and postoperative investigations of vocal cord movements. Calcemia and phosphoremia were systematically evaluated preoperatively and on day 1 and day 2 after surgery. All patients presenting a postoperative calcemia below 1.90 mmol/l were considered to present an early postoperative hypoparathyroidism and received calcium-vitamin D therapy. The hypoparathyroidism was considered permanent when calcium-vitamin D therapy was still necessary 1 year after surgery. RESULTS: None of the patients presented permanent nerve palsy. There were three cases of transient nerve palsy (6%) in Group 1 and two (4%) in Group 2. In Group 1 there was no permanent hypoparathyroidism and four cases of transient hypoparathyroidism (8%). In Group 2, seven patients presented transient hypoparathyroidism (14%) and two patients (4%) remained with definitive hypoparathyroidism. CONCLUSION: After total thyroidectomy for PTC, PCND does not increase recurrent laryngeal nerve morbidity but it is responsible for a high rate of hypoparathyroidism, especially in the early postoperative course. Even taking into account the possible benefits, the results make it difficult to advocate PCND as a routine procedure in all patients presenting a PTC.

Carcinoma, Papillary↗
PubMed2006

Established prognostic variables in N0 oral carcinoma.

OBJECTIVES: To examine the utility of established prognostic variables in patients with oral carcinoma and a clinically negative neck. STUDY DESIGN: Retrospective cohort study. METHODS: The distribution of occult metastases was assessed in 105 oral cancer patients with no clinical or radiological evidence of nodal disease. Predictors for nodal metastases, recurrence, and survival were examined. RESULTS: Occult neck metastases occurred in 34 percent of patients. Tumor thickness was the only independent predictor of occult metastases, with thin (</=5 mm) and thick (>5 mm) tumors having a 10 percent and 46 percent incidence of regional disease, respectively (P = 0.001). Nodal metastases and perineural invasion were significant predictors of survival. CONCLUSION: Patients with thick tumors are at high risk of nodal metastases and are likely to benefit from elective neck dissection. Comprehensive neck dissection should be considered in advanced primary disease. SIGNIFICANCE: Tumor thickness is the most important predictor of occult regional metastases in oral cavity cancer.

Cohort Studies↗
PubMed1996

[The reasons for failures of laryngeal cancer surgeries].

In 4 ENT Clinics of Medical Academies in Poznań, Warszawa, Kraków, Lublin 2620 laryngeal cancer patients were operated upon during the years 1980-1987. The treatment failure occurred in 760 cases (29%). The following possible to discover factors were probably responsible for unsuccessful results: senility, other concomitant diseases (especially cardiac), prolonged diagnostic procedure, no up to date diagnostic methods, giving up the radiotherapy (38% of cases), upper laryngeal localization of tumors (87%), advanced extents T3 and T4 (83%), advanced clinical stages of cancer (III degrees and IV degrees 85%), lack of surgical radicality especially in neck dissection, unsuccessful neck dissection behind the accessory nerve, omittance of taking the specimens to the pathomorphologic examinations from the marginal part of the operational field in 25% of patients. The early recurrences in these places in apart of patients spoke for the presence of the neoplasmatic cells in this region.

Adult↗