Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Neck Dissection”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,171 records · Page 65Linked to original sources
PubMed2002

[Rule of lymph node metastasis in the cancer of mouth floor and its treatment].

BACKGROUND & OBJECTIVE: There was little report on the rule of lymph node metastasis in the cancer of mouth floor. The aim of this study was to investigate the rule of lymph node metastasis and investigate the reasonable treatment. METHODS: A total of 79 cases with squamous carcinoma of mouth floor were included into this study retrospectively. The distributive difference of clinical and pathological positive lymph node was compared. The recurrent rate of the patients who were performed with radical neck dissection and supra-half-neck dissection in clinical positive lymph node group were compared with the recurrent rate of the patients who were preformed with radical neck dissection, supra-half-neck dissection, submandibular triangle dissection, and clinical observational group. RESULTS: Clinical and pathological positive lymph node was found mainly in II region (61.8% and 40.0%, respectively), secondly in I and/or III region, and rarely in IV, V, and VI region. In clinical positive lymph node group, the recurrent rate of the patients who performed with radical cervical neck dissection was lower than supra-half-neck dissection, but without statistical significance (chi 2 = 3.403, P = 0.065). In clinical cervical negative lymph node group, the recurrent rates of the patients performed with supra-half-neck, submandibular triangle dissection, and in clinical observational group were 11.1% (1/9), 40.0% (2/5), and 23.5% (4/17), without statistical significance (chi 2 = 1.554, P = 0.46). CONCLUSION: Lymph node metastasis of cancer of floor of mouth mainly distributes in I, II, III region; The patients with negative cervical lymph node should be performed lymph node dissection in I, II, III region (supra-half-neck).

Adult↗
PubMed2005

[Clinical analysis of cervical metastatis from an unknown primary carcinoma].

From 1997 to 2004, 19 cases-18 men and 1 woman-with cervical lymph node metastasis from an unknown primary carcinoma were retrospectively investigated regarding the clinical observation and the treatment outcome. With respect to the histopathological types, 16 cases had squamous cell carcinoma, 2 cases had adenocarcinoma and 1 case had ductal carcinoma. As for the region of lymph node metastasis with maximum size, metastasis located in the upper deep cervical region arrounted for 84%. The presence of primary lesions was comfirmed in 11 cases (3 tonsil, 1 nasopharynx, 1 base of tongue, 2 hypopharynx, 1 esophagus, 1 larynx, 1 gallduct, 1 mammary gland) after the treatment of their metastatic leisions. Tonsillectomy and Blind biopsy were effective for 5 patients. Seventeen patients were treated with neck dissection. Eleven patients with neck dissection underwent radiotherapy. The overall 3-year survival rate as determined by the Kaplan-Meier method was 62%. The 3-year survival rate of the 17 cases whose metastatic leisions were treated with radical neck dissection was 66%. The 3-year survival rate of cases with known primary sites and cases with unknown primary sites after treatment were 55% and 83%, respectively. Radiotherapy with radical neck dissection was thought more effective than radical neck dissection for local and neck control.

Adenocarcinoma↗
PubMed1997

[Pharyngo-cutaneous fistula after total laryngectomy].

The charts of 319 consecutive patients who underwent total laryngectomy at the Cancer Institute Hospital from 1971 to 1994 were reviewed in order to clarify the relationship between pharyngo-cutaneous fistula formation and age, the dose of pre-operative radiation and radical neck dissection, as well as the need for subsequent surgical repair. The patients did not need to undergo reconstruction by flaps at the time of laryngectomy. Radiation sources were limited to X ray radiotherapy and Cobalt 60. Of the 319 patients 204 (63.9%) underwent neck dissection. Both radical neck dissection and modified radical neck dissection were classified as neck dissection. The chi-square test was used to construct a table of the three parameters age, dose of radiation and neck dissection. With respect to age, the incidence of fistula formation was 13.4% (16 patients of 119) in patients at the age of 59 and below, 5.9% (7/118) in those from 60 to 69, and 8.5% (7/82) in those at 70 years and above. Our analysis reveals that the age at the time of surgery is not a predisposing factor for fistula formation in the three age groups (59 and below, between 60 and 69, and 70 and above). Similarly the need for subsequent surgical repair is also not age-related. With respect to radiation, the incidence of fistula formation was 8.0% (4/50) for patients who received radiotherapy less than 20 Gy, 6.3% (2/32) in those who received between 20 and 40 Gy, 2.6% (2/77) in those who received between 40 and 60 Gy, 13.2% (20/152) in those who received between 60 and 80 Gy and 25.0% (2/8) in those who received over 80 Gy. When the preoperative dose of radiation was divided into three classes, that is, less than 40 Gy, 40 to 60 Gy and over 60 Gy, we observed that the incidence of fistula formation increased significantly in the patients who received over 60 Gy. Surgical repair was also indicated more frequently for those patients who received over 60 Gy than for those who received less than 60 Gy. With respect to neck dissection, the incidence of fistula formation was 12.2% (14/115) for the patients who did not undergo neck dissection or those who underwent only lymphadenectomy, 7.8% (9/115) for the patients who underwent unilateral neck dissection, and 7.9% (7/89) for those who underwent bilateral neck dissection. These data reveal that neck dissection, whether unilateral or bilateral, dose not increase the incidence of fistula formation, nor the need for subsequent surgical repair. Fistulae were present in 30 patients (9.4%) for 24 years, and 14 of these 30 patients did not need subsequent surgery. In these 30 patients with fistulae, we did not find patients with systemic disease such as diabetes mellitus prior to the surgery. When the period of 24 years was divided into 4 periods, the incidence of fistula formation was 19.0% (from 1971 to 1976), 6.9% (from 1977 to 1982), 10.3% (from 1983 to 1989) and 2.6% (from 1989 to 1994), that of the latest period was the lowest with gradual improvement. The average dose of preoperative radiation was 57.7 Gy (from 1971 to 1976), 50.8 Gy (from 1977 to 1982), 39.6 Gy (from 1982 to 1988) and 45.7 Gy (from 1989 to 1994) and reduction in dose of radiation seemed to be one of the reasons for the lower frequency of fistula. Several surgeons performed the operations for different patients, but the procedure of laryngectomy was recently directed by an experienced surgeon. The study also indicates that the risk of fistula formation is reduced not only by the dose of radiation but also by improved surgical skill.

Adult↗
PubMed2005

The role of FDG PET in management of neck metastasis from head-and-neck cancer after definitive radiation treatment.

PURPOSE: The role of neck dissection after definitive radiation for head-and-neck cancer is controversial. We select patients for neck dissection based on postradiation therapy (post-RT), computed tomography (CT), and [18F] fluorodeoxyglucose positron emission tomography (FDG PET). We summarize the clinical outcomes of patients treated with this policy to further elucidate the role of FDG PET in decision making for neck dissection after primary radiotherapy. METHODS AND MATERIALS: Between December 1999 and February 2004, 53 eligible patients were identified. These patients had stage N2A or higher head-and-neck squamous cell carcinoma and had complete response of the primary tumor after definitive radiation with or without chemotherapy. PET or computed tomography (CT) scans were performed within 6 months after treatment. Neck dissection was performed in patients with residual lymphadenopathy (identified by clinical examination or CT) and a positive PET scan. Those without residual lymph nodes and a negative PET were observed without neck dissection. For patients with residual lymphadenopathy, but a negative PET scan, neck dissection was performed at the discretion of the attending surgeon and decision of the patient. There was a total of 70 heminecks available for analysis (17 patients had bilateral neck disease). RESULTS: There were 21 heminecks with residual lymphadenopathy identified on CT imaging or clinical examination and negative PET. Of these, 4 had neck dissection and were pathologically negative. The remaining 17 were observed without neck dissection. There was a total of 42 heminecks without residual lymph nodes on post-RT CT imaging or clinical examination with a negative PET. They were also observed without neck dissection. Seven heminecks had a positive PET scan and residual lymphadenopathy. Six of them had neck dissection and 1 had fine-needle aspiration of a residual node; 3 contained residual viable cancer and 4 were pathologically negative. At median follow up of 26 months (range, 12-57 months), no regional failure was identified. The negative predictive value of PET was 100% and positive predictive value was 43%. CONCLUSION: For patients who have no evidence of residual lymphadenopathy and a negative FDG PET scan 12 weeks after definitive radiation, neck dissection can be safely withheld. Even in cases in which small residual lymphadenopathy was observed, regional recurrences have not occurred when the post-RT PET scan was negative and neck dissection was withheld. For patients with large residual lymphadenopathy (greater than 2.0-3.0 cm in size) but a negative post-RT FDG PET, further studies with longer follow-up are necessary to determine the appropriateness of withholding neck dissection.

Adult↗
PubMed1996

Lower gingival carcinoma. Clinical and pathologic determinants of regional metastases.

OBJECTIVE: To determine which clinical and pathologic features are associated with regional metastases in patients with lower gingival squamous cell carcinoma. PATIENTS AND METHODS: The medical charts of 155 previously untreated patients seen between 1970 and 1990 were retrospectively analyzed. All patients underwent surgical resection of the primary tumor. In addition, 66 patients underwent elective neck dissection, while a therapeutic neck dissection was performed in 28. Sixty-one patients who had clinically N0 neck disease did not undergo treatment of the cervical lymphatics. RESULTS: T stage (P = .01), radiologic (P = .03) or histologic (P = .01) evidence of mandibular invasion, and decreased tumor differentiation (P = .004) significantly correlated with the presence or evolution of regional metastases. In addition, tumors involving the symphyseal region were associated with an increased incidence of nodal metastases, although the relationship did not achieve statistical significance (P = .08). Occult regional disease was found in 18% of patients who underwent elective neck dissection, and the presence of metastases was pathologically confirmed in 68% who underwent a therapeutic dissection. Six patients with clinically N0 neck disease did not undergo elective dissection and later developed regional metastases. In all patients, survival was adversely impacted by the presence or later development of regional metastases (P < .001). Two- and 5-year survival rates for patients with no cervical metastases were 0.91 and 0.85, respectively, while for those with cervical metastases, the survival at 2 and 5 years declined to 0.72 and 0.59. More importantly, the 2- and 5-year survivals of patients with clinically N0 necks who were found to have lymph node metastases histologically after neck dissection were 1.00 and 0.78. This contrasts with the 0.50 survival rate at 2 and 5 years for those who did not undergo elective dissection and later developed cervical metastases (P = .36). CONCLUSIONS: Patients with adverse clinical and pathologic features, even in the absence of demonstrable neck disease, are at risk for harboring regional metastases. Elective treatment of the cervical lymphatics should be considered for patients with primary tumors that overlie the mandibular symphysis, moderately or poorly differentiated tumors, or radiographic or histologic evidence of mandibular invasion.

Adult↗
PubMedDate not supplied

[Management of lymph node metastases in well-differentiated and medullary thyroid cancer: retrospective study on 52 cases].

OBJECTIVE: To define the surgical principles of neck dissections as applied to the head and neck squamous cell carcinomas, extending their rationale to treatment of lymph nodes metastases from thyroid carcinomas. MATERIALS AND METHODS: Between January 1994 and June 2002, 52 patients affected by well-differentiated thyroid cancers (1 follicular, 9 medullary, and 42 papillary cancers) underwent uni- or bilateral neck dissections at our Department, for a total of 73 neck dissections. Patients were subdivided into 2 groups: 37 simultaneously treated on the thyroid and the neck (Group A), and 15 operated elsewhere on the thyroid and for a neck recurrence and/or persistence at our Department (Group B). RESULTS: 48 patients underwent a regular follow-up (range: 3-86 months, mean: 38). Among patients alive with disease, 5 in Group A and 4 in Group B had a local-regional recurrence. In particular, 2 patients for each group (2 medullary and 2 papillary cancers) had a regional recurrence on the N site, at the level of one or more lymph nodes "in field" as regards the neck dissection previously performed. Moreover, in all these patients a local recurrence on the T site has been observed. DISCUSSION: Lymph nodes metastases have a minor prognostic impact in well-differentiated thyroid cancers in respect of the rest of head and neck cancers. Nonetheless, when performing a curative or elective neck dissection, the gold standard surgical principles must be the same. As a matter of fact, a 20% incidence of lymph nodes metastases at the V level, often not specifically addressed in neck dissections for thyroid cancers, it is noteworthy. Aim of such an aggressive surgical approach of the neck is to obtain a low incidence of "in field" regional recurrences, which become no more amenable of a subsequent surgical salvage. CONCLUSION: Surgical techniques as lymphadenectomy or "pick-berry procedure" must be abandoned because they do not respect the basic anatomic, physiopathologic, and oncologic principles of neck dissections along cervical fasciae and spaces.

Adenocarcinoma, Follicular↗
PubMed2006

The role of positron emission tomography scans in the management of the N-positive neck in head and neck squamous cell carcinoma after chemoradiotherapy.

OBJECTIVE: The objective of this study was to determine the sensitivity, specificity, and predictive value of 18-fluorodeoxyglucose positron emission tomography (PET) in predicting residual cervical metastatic disease in patients with N-positive necks undergoing curative radiotherapy and chemoradiotherapy for squamous cell carcinoma (SCC) of the upper aerodigestive tract. METHODS: The authors studied a prospective case series of patients (2003-2005) of patients undergoing radiotherapy and chemoradiotherapy for advanced head and neck SSC. Study entry criteria included N-positive neck disease, a complete response to treatment at the primary tumor site, posttreatment PET scan (8-12 weeks after completion of treatment), followed by salvage neck dissection. The posttreatment PET scan neck findings were correlated to the salvage neck dissection pathology report. The sensitivity, specificity, and predictive values of the PET scan to predict residual cervical metastatic disease after curative chemoradiotherapy were calculated. RESULTS: Twenty-one neck dissections (pretreatment N1 = 5, N2a = 2, N2b = 8, N3 = 6) were entered into the protocol. Four (19.0%) of the 21 neck specimens were positive for residual cervical metastatic disease, whereas the remaining 17 (80.9%) specimens demonstrated no residual carcinoma. The overall sensitivity and specificity were 75.0% and 64.7%, respectively. The positive predictive value was 33% and the negative predictive value was 91.7%. CONCLUSIONS: Although the role of posttreatment neck dissection remains controversial, the surgeon must rely on clinical examination and imaging studies. Our practice has been to perform planned staged neck dissections on all N2 and N3 necks, as well as N1 necks with an incomplete response to treatment. Based on this small prospective study, it appears that PET imaging lacks adequate sensitivity and specificity to reliably predict the presence of residual cervical metastatic disease after completion of chemoradiotherapy. With a negative predictive value of 91.7%, however, a negative PET scan appears to be a reliable predictor of the absence of residual tumor.

Aged↗
PubMed1994

Clinical experiences with surgical therapy of cervical metastases from head and neck cancer.

Indications for the various techniques of neck dissection can undergo substantial variations according to the metastatic picture found, biological aggressiveness of tumor, nodal volume and personal philosophies of the attending clinician. In the present paper we report our clinical experience with radical neck dissections, "functional" neck dissections and selective neck dissections-in total, 1658 neck dissections carried out between 1976 and 1991. We discuss the indications and contra-indications of the various surgical techniques of neck dissection and evaluate the long-term results. Our current preference is to use the Suarez-Bocca "functional" technique of neck dissection for prophylactic treatment of the neck and for therapeutic treatment of the neck when intracapsular metastases already exist.

Combined Modality Therapy↗
PubMedDate not supplied

Neuromuscular dysfunction after surgical treatment of oral cancer.

Surgical treatment of oral cancer usually includes radical dissection of the neck, in which the sternocleidomastoid muscle is sacrificed. In modified neck dissection the accessory nerve is spared, but may be severed by e.g. manipulation. The facial nerve may also be severed by traction or distension. We have done an electromyographic study of 35 patients, 20 men and 15 women, aged from 21 to 92 yrs, 6 to 176 months after oral cancer operation. EMG findings of the upper trapezius muscle were normal in only six of 32 patients who had had a radical or upper neck dissection, although the accessory nerve had been identified and spared during surgery. The surgeons' evaluation of the risk to the facial nerve was in good correlation to EMG findings, both the orbicularis oris and the mentalis muscle were better preserved, if the risk was considered minor. The loss of motor units in voluntary contraction and the nerve latencies to the muscles were in good correlation to many factors from the spectral analysis of the EMG, e.g. to the root mean square (RMS), to the mean rectified value (MRV), to the mean amplitude and to the number of turns. The accessory nerve is easily damaged, and the injury is often not noted during neck dissection. Significant problems may also arise with lesions of the facial nerve. Quantitative EMG analysis may add to sensitivity of the postoperative EMG studies.

Accessory Nerve↗
PubMed2002

Efficacy of selective lymph node dissection in clinically negative neck.

OBJECTIVE: The purpose of this study was to evaluate the efficacy of selective neck dissection (SND) for elective treatment of the clinically negative neck in head and neck squamous cell carcinoma (SCC). METHODS: A retrospective review was undertaken on 91 previously untreated patients with T1-4 SCC of oral cavity (23), oropharynx (5), hypopharynx (7), larynx (56), and clinically negative neck (N0), undergoing 126 SND from January 1990 to March 1999 at a single institution. Twenty-five patients received postoperative radiation therapy on the basis of histologic evidence of >2 positive nodes, extracapsular spread (ECS), and/or the presence of advanced primary lesion. RESULTS: On pathologic examination the average number of lymph nodes was 20.5 per neck, occult disease was detected in 14 (11.11%) of 126 necks; of necks with positive nodes, 6 (42.85%) of 14 had ECS. The median follow-up was 36 months. Overall recurrence rate (local, regional, and distant) was 12.8% (11 of 91). Recurrent disease developed in the neck of one patient, outside the dissected field. There was no difference in recurrence rate between pN0 and pN+ patients, as well as between pN+ with or without ECS. Overall survival rate was 84% (77 of 91), with a statistically significant difference between pN0 and pN+ necks. CONCLUSION: SND seems to be a pragmatic approach that is as effective as comprehensive procedures for staging and treating the clinically negative neck.

Adult↗
PubMed2001

Familial thyroid cancer.

Familial thyroid cancer can arise from parafollicular cells (familial medullary thyroid cancer) or from follicular cells (familial nonmedullary thyroid cancer). Familial medullary thyroid cancer may occur in isolation or as part of multiple endocrine neoplasia (MEN) type II syndromes. Genetic testing for a RET mutation on chromosome 10 is used to identify new family members who are gene carriers. Total thyroidectomy should be used in gene carriers without clinical disease before age 6 in medullary thyroid cancer and MEN type IIA, and as soon as the diagnosis is made in MEN type IIB after the first year of life. Those with clinical disease should have at least a bilateral central neck dissection. Modified radical neck dissection is recommended for patients when the primary tumor is 1.5 cm. A normal postoperative serum calcitonin level suggests that the operation has been curative. Physicians need to be aware of ethical and lifestyle issues related to patients with familial disease and their family members. Familial nonmedullary thyroid cancer occurs as a discrete entity or as part of other family cancer syndromes such as Gardner syndrome, Cowden disease, and other rare syndromes. Familial nonmedullary thyroid cancer almost exclusively includes patients with papillary or Hurthle cell cancers. These families appear to have more benign thyroid conditions. The gene (or genes) for familial papillary thyroid cancer is yet to be identified, whereas that for some Hurthle cells (TCO) has been mapped to chromosome 19p13.2. Familial nonmedullary thyroid cancer is somewhat more aggressive than its sporadic counterpart, but is less aggressive than medullary thyroid cancer. Total thyroidectomy and central neck dissection followed by radioactive iodine ablation and thyroid hormone suppression appear to be the most effective therapy.

Adolescent↗
PubMed2003

[A clinical study of ultrasonography for lymph node metastases in head and neck cancer].

Ultrasonography (US) is very useful in evaluating cervical lymph node swelling in head and neck cancers. We studied problems with US in evaluating lymph nodes. Cervical lymph nodes were removed by radical neck dissection or modified radical neck dissection from 79 patients with squamous cell carcinoma in the head and neck. We studied the correlation between preoperative US findings and the histopathological features. Preoperative lymph nodes were measured three-dimensionally. We diagnosed lymph nodes as metastases when they meet two criteria: One is the shortest diameter exceeding 7 mm in level I and II and 6 mm in level III, IV and V. The other is shortest to longest diameter ratio exceeding 0.5. A total of 2004 lymph nodes were removed by neck dissection, and 199 lymph nodes were diagnosed histopathologically as metastases. Of the 199 metastatic lymph nodes, 93 (46%) were diagnosed as metastases by preoperative US findings and 33 (17%) were false negative. Thirty-six cases were diagnosed preoperatively as N0 by US findings, but 15 of these were pN(+) histopathologically. In the 15 cases, 21 lymph nodes were metastases. Of the 21 metastatic lymph nodes, 10 nodes were not detected by US. Thirty-one cases were diagnosed preoperatively as N1 by US findings, but 20 of these were pN2b histopathologically. In the 20 cases, 66 lymph nodes were metastases. Of the 66 metastatic lymph nodes, 46 were not diagnosed as metastases. They often located distant level from the lymph node diagnosed correctly as a metastasis. US is very useful in evaluating cervical lymph node metastasis, but it has the limitations indicated above. If 1 metastatic lymph node is detected by US, there will be multiple metastatic lymph nodes and sometimes they are distant from the original level. Radical neck dissection should be done for positive lymph nodes detected by US findings. If a lymph node is not clearly a metastasis, fine-needle aspiration cytology (FNA) should be done, because it provides more accurate diagnosis for metastatic lymph nodes.

Carcinoma, Squamous Cell↗
PubMed2002

Evaluation of selective lymph node sampling in the node-negative neck.

OBJECTIVE: To determine whether intraoperative selective lymph node sampling before neck dissection in the node-negative (N0) neck accurately reflects the disease content of the neck and can be used to assist in treatment selection. STUDY DESIGN: A prospective clinical study at a university medical center. METHODS: Over a 2-year period, 36 patients with head and neck squamous cell carcinoma scheduled to undergo 41 elective neck dissections were enrolled. At the initiation of the neck dissection, biopsy of the "most suspicious" lymph node within the tumor's primary nodal drainage basin was performed, and the specimen was measured and sent for frozen-section evaluation. The results of lymph node sampling were compared with the final histopathologic interpretation of the resected primary and neck dissection. RESULTS: Of the 41 N0 necks, 29% (12 of 41) were positive for occult metastases. Results of selective lymph node biopsy correlated with the results of neck dissection in 34 of 41 specimens (83%). The specificity and positive predictive value of node sampling were both 100%. The proportion of cases with a positive neck dissection with a positive sampled node (sensitivity) was 42% (5 of 12). CONCLUSION: The results of selective lymph node biopsy with frozen-section analysis in the N0 neck, as defined in the current study, did not reflect a technique with adequate sensitivity to alter intraoperative treatment strategy.

Adult↗
PubMed2003

[The importance of lymph node dissection in medullary thyroid macrocarcinomas].

UNLABELLED: Medullary thyroid carcinoma (MTC) is often regarded as good medium-term forecast. The 5- and 10-years survival rates are, respectively, appraised at 78-85% and 70-78%. These rates take no care, however, of the fact that 50-56% of the patients keep a pathological calcitonine (CT) level giving evidence of an evolutive disease. The treatment is based on the total thyroidectomy and cervical lymphadectomy. This treatment remains often incomplete and the results of reintervention are disappointing. AIM OF THE STUDY: About 48 patients, we wanted to demonstrate the importance of a complete lymph node dissection performed in the neck as soon as possible. PATIENTS AND METHODS: Between 1979 and 2000, 48 patients were treated for macroMTC (size >1 cm). The duration of follow-up was of 1-29 years (mean 9.3 years). The complete (central and lateral) neck dissection was initially made only in 22 cases. The selected criterion to assess the result was the normalization of the basal CT level. RESULTS: The rate of node involvement was 66.6% if the complete lymphadectomies (n = 22), the secondary neck dissections (n = 15), the incomplete (n = 10) and not made lymphadectomies (n = 2) were gathered. In case of primary or secondary complete lymphadectomies, the rate of node involvement was 81%. The 22 primary complete lymphadectomies performed in 13 patients (59%) allowed to normalize the basal CT level and among 17 (77.2%) to decrease this rate over 90%. All the incomplete neck dissection failed in case of positive nodes. CONCLUSION: The frequency of node involvement in macroMTC is about 80%. It does not have a preferential territory and the bilaterality is frequent (28-49%): that justifies a bilateral complete neck dissection. Initial surgical treatment seems essential in regard to the rate of normalization of basal CT level, which is, when a first complete lymphadectomy is done and in case of iterative surgery, respectively 59 and 26.6%. A complete lymphadectomy is still too rarely carried out: 22 times (45.8%) in our own experience and from 14 to 42% in the literature.

Adult↗
PubMed2002

The node-negative neck: accuracy of clinical intraoperative lymph node assessment for metastatic disease in head and neck cancer.

OBJECTIVES/HYPOTHESIS: Often, the type of neck dissection performed in patients with head and neck malignancy is finally determined by intraoperative assessment of clinically suspect lymph nodes by frozen section. This prospective study aimed to assess the accuracy of clinical intraoperative lymph node assessment and therefore to examine validity of the underlying assumption that the surgeon can consistently identify nodes that contain metastatic tumor. We also aimed to assess whether gross morphological characteristics of the lymph nodes examined could be correlated with nodal status and therefore used to predict those nodes containing metastatic disease. STUDY DESIGN: A prospective study assessing the accuracy of clinical intraoperative lymph node assessment in the node-negative neck. METHODS: Forty-six neck dissections from 34 patients with head and neck cancer were prospectively examined intraoperatively by a single surgeon. All obvious nodes were clinically assessed, morphologically described, and subsequently correlated with pathological findings. RESULTS: Sixty palpable nodes were identified in 32 neck dissections. They were clinically categorized as malignant or suspect (22) or benign (38). Pathological examination revealed a false-positive rate of 30% and a false-negative rate of 44%. The sensitivity of intraoperative lymph node assessment was 56%, and the specificity was 70%. Apart from "infiltration," morphological characteristics could not be correlated with nodal status. In the 14 neck dissections with no obviously palpable lymph nodes, 4 (29%) were positive for metastatic disease. CONCLUSIONS: In the node-negative neck, intraoperative assessment does not seem to improve the accuracy of staging. The only parameter of benefit and correlating with metastatic disease is clinical evidence of infiltration. The assumption that frozen section is a good determinate for selection of type of neck dissection is questionable. If selective neck dissection is not found to be therapeutic, its use leads to over-reliance on other therapeutic treatment such as postoperative radiotherapy, depriving the patient of a potential useful treatment modality in cases of locoregional recurrence.

Carcinoma, Squamous Cell↗
PubMed2005

Prevalence of lymph nodes in the apex of level V: a plea against the necessity to dissect the apex of level V in mucosal head and neck cancer.

BACKGROUND: We assessed the prevalence of histologically proven normal or invaded lymph nodes in the apex of level V. METHODS: Seventy neck dissections were performed in 41 patients with mucosal head and neck squamous cell carcinoma (SCC). Fifty-one neck dissections were performed in 30 previously untreated patients (group 1); 19 neck dissections were carried out in 11 patients previously irradiated (group 2). RESULTS: Pathologic analysis was unable to identify any lymph node in 70% of the apex specimens. In group 1, no lymph nodes were detected in 63%, whereas one or more noninvaded lymph nodes were present in 37%; in group 2, no lymph nodes were identified in 89%, whereas one or more normal lymph nodes were found in 11% (p = .03). Metastatic lymph nodes were never identified. CONCLUSIONS: The prevalence of lymph nodes in the apex was 30%. No invaded lymph nodes were identified. In addition to anatomic evidence, these results suggest that dissection of the apex is not necessary in mucosal head and neck SCC.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Lateral neck mass as the initial manifestation of thyroid carcinoma.

Of 238 thyroid cancer patients, 24 exhibited a lateral neck mass as the initial presentation. Twenty four (77.4%) of 31 metastatic masses were located at the midjugular and lower jugular lymph chains. The average number of histologically proven metastatic nodes was 6.5. Histologically, 22 cases were diagnosed as papillary carcinoma, 1 as follicular carcinoma, and the remaining case as medullary carcinoma. Fifteen thyroid glands were found to have a single primary focus, while 9 others had multiple foci. The mean diameter of the primary foci was 1.2 cm. The rates of detection of primary foci by thyroid scan and ultrasonography were 60% and 37.5%, respectively. Surgical procedures for the thyroid lesions included total or near-total thyroidectomy in 18 cases and lobectomy in 6 cases; for metastatic neck nodes, 13 were treated by modified neck dissection, 5 by standard radical neck dissection, and six by partial neck dissection. All 24 patients were followed for a mean duration of 4.5 years with a range of 2.0 to 7.5 years, and all except 1 are still living. In the presence of a lateral neck mass as the initial manifestation of thyroid carcinoma, no matter what size the primary tumor foci, a total or near-total thyroidectomy appears to be justified in addition to an appropriate neck dissection.

Adenocarcinoma↗
PubMed2001

Supracricoid laryngectomy with CHEP: functional results and outcome.

OBJECTIVES: To assess whether supracricoid laryngectomy with cricohiodoepiglottopexy could successfully reach the cure and preserve the voice in glottic laryngeal cancer, we studied 27 patients with T2/T3 squamous cell carcinoma of the larynx treated in our institution with cricohiodoepiglottopexy. STUDY DESIGN: A retrospective analysis has been carried out between 1995 through 1997. We classified 11 patients as T2N0M0 and 16 patients as T3N0M0. Nineteen patients had bilateral selective lateral neck dissection, 3 patients had unilateral lateral neck dissection, and 5 patients had undissected neck. Survival was analyzed under the Kaplan-Meyer method. RESULTS: Five patients had postoperative complications, 2 were treated with a total laryngectomy. The remaining 25 patients kept the normal airway, swallowing, and speech. None of the patients in the neck dissection group had neck metastasis. Two patients had recurrences, 1 with local recurrence was treated with a total laryngectomy and is alive without disease; the other patient had neck recurrence, was treated with radical neck dissection plus radiotherapy, and is dead of the disease. One patient had a second tumor in oropharynx treated with palliative radiotherapy and is dead of the disease. Three years disease-free survival was 75% for T2 and 79% for T3. CONCLUSIONS: This technique is useful in the treatment of selected cases of T3/T2 glottic cancer regarding the extent of disease. The incidence of complications in need of a complete laryngectomy does not compromise the functionality of this technique. The survival is comparable to patients who submitted to total laryngectomy and near-total laryngectomy, regarding the extent of the lesion.

Adult↗