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The therapeutic role and effectiveness of selective neck dissection in the management of N0 neck

Year 2009, Volume: 19 Issue: 4, 192 - 197, 18.08.2009

Abstract

Objectives: To assess the therapeutic role and the effectiveness of the selective neck dissection in the management of the clinically node negative neck in the head and neck squamous cell carcinomas. Patients and Methods: The charts of 177 patients with squamous cell carcinoma, who underwent neck dissection between January 2000 and January 2007, were reviewed retrospectively. Seventy neck dissections in 58 patients 51 males, 7 females; mean age 63 years; range 21 to 85 years in whom the primary site of the lesion was the larynx, oral cavity, oropharynx and hypopharynx, and who were considered to have N0 neck and to comply with the study criteria were included in the study. Details were collected on tumor site and stage, type of surgery, pathologic N stage, number and size of pathologic nodes, extracapsular spread of nodes, postoperative radiotherapy, local recurrence, follow up time and survival status in all patients. Results: It was found out that selective neck dissection operations were performed on 99 of 102 N0 patients. The follow up time was approximately 23 months in 58 patients who who were found to comply with the inclusion criteria. The most frequent site for primary tumor was larynx and most patients were at T2 stage. Nine patients had pathologically positive lymph node with occult metastasis rate of 13%. The overall recurrence rate was 19%. Postoperative radiotherapy was used as adjuvant therapy in 15 patients. Regional control rate was lower in patients with pathologically positive lymph nodes. However, it was not statistically significant. Conclusion: Selective neck dissection is an effective and safe method for controlling and staging of the patients with clinically N0 neck.

References

  • Davidson J, Khan Y, Gilbert R, Birt BD, Balogh J, MacKenzie R. Is selective neck dissection sufficient treatment for the N0/Np+ neck? J Otolaryngol 1997; 26:229-31.
  • Hosal AS, Carrau RL, Johnson JT, Myers EN. Selective neck dissection in the management of the clinically node-negative neck. Laryngoscope 2000;110:2037-40.
  • Pitman KT, Johnson JT, Myers EN. Effectiveness of selective neck dissection for management of the clini- cally negative neck. Arch Otolaryngol Head Neck Surg 1997;123:917-22.
  • Traynor SJ, Cohen JI, Gray J, Andersen PE, Everts EC. Selective neck dissection and the management of the node-positive neck. Am J Surg 1996;172:654-7.
  • Mafee MF, Valvossori GE, Becker M. Imaging of the head and neck. 2nd ed. New York: Thieme Medical Publishers; 1995.
  • Inohara H, Enomoto K, Tomiyama Y, Yoshii T, Osaki Y, Higuchi I, et al. The role of CT and (18)F-FDG PET in managing the neck in node-positive head and neck cancer after chemoradiotherapy. Acta Otolaryngol 2008:1-7.
  • Yamazaki Y, Saitoh M, Notani K, Tei K, Totsuka Y, Takinami S, et al. Assessment of cervical lymph node metastases using FDG-PET in patients with head and neck cancer. Ann Nucl Med 2008;22:177-84.
  • Nahmias C, Carlson ER, Duncan LD, Blodgett TM, Kennedy J, Long MJ, et al. Positron emission tomogra- phy/computerized tomography (PET/CT) scanning for preoperative staging of patients with oral/head and neck cancer. J Oral Maxillofac Surg 2007;65:2524-35.
  • Ferlito A, Silver CE, Rinaldo A. Selective neck dissec- tion (IIA, III): a rational replacement for complete func- tional neck dissection in patients with N0 supraglottic and glottic squamous carcinoma. Laryngoscope 2008; 118:676-9.
  • Clayman GL, Frank DK. Selective neck dissection of anatomically appropriate levels is as efficacious as modified radical neck dissection for elective treat- ment of the clinically negatice neck in patients with squamous cell carcinoma of the upper respiratory and digestive tracts. Arch Otolaryngol Head Neck Surg 1998;124:348-52.
  • Coskun HH, Erisen L, Basut O. Selective neck dissec- tion for clinically N0 neck in laryngeal cancer: is dis- section of level IIb necessary? Otolaryngol Head Neck Surg 2004;131:655-9.
  • Erdağ TK, Karas C, Ikiz AO, Güneri EA, Ceryan K, Sarioğlu S. The incidence of level I metastasis in lar- yngopharyngeal squamous cell carcinoma. [Article in Turkish] Kulak Burun Bogaz Ihtis Derg 2003;11:166-9.
  • Katilmiş H, Öztürkcan S, Özdemir I, Tuna B, Güvenç IA, Özkul Y. Is dissection of level 4 and 5 justified for cN0 laryngeal and hypopharyngeal cancer? Acta Otolaryngol 2007;127:1202-6.
  • Çağli S, Yüce I, Güney E. Is routine inclusion of level IV necessary in neck dissection for clinically N0 supraglottic carcinoma? Otolaryngol Head Neck Sur 2007;136:287-90.
  • Özdek A, Yılmaz T, Saraç S, Turan E, Kaya S. Larenks kanserlerinde tümör lokalizasyonuna göre boyun metastazlarının dağılımı. Kulak Burun Boğaz ve Baş Boyun Cerrahisi Dergisi 1999;7:52-4.
  • Alvi A, Johnson JT. Extracapsular spread in the clini- cally negative neck (N0): implications and outcome. Otolaryngol Head Neck Surg 1996;114:65-70.
  • Byers RM, Clayman GL, McGill D, Andrews T, Kare RP, Roberts DB, et al. Selective neck dissections for squamous carcinoma of the upper aerodigestive tract: patterns of regional failure. Head Neck 1999;21:499-505.

N0 boyun tedavisinde selektif boyun diseksiyonunun tedavideki rolü ve etkinliği

Year 2009, Volume: 19 Issue: 4, 192 - 197, 18.08.2009

Abstract

Amaç: Bu çalışmada baş-boyun yassı hücreli karsinomlarında klinik olarak negatif olan boyunların tedavisinde selektif boyun diseksiyonunun etkinliği ve tedavideki rolü değerlendirildi. Hastalar ve Yöntemler: Ocak 2000 ve Ocak 2007 tarihleri arasında yassı hücreli karsinom tanısıyla ameliyat edilen 177 hastanın hastane kayıtları geriye dönük olarak incelendi. Primer lezyon yeri; oral kavite, orofarenks, hipofarenks ve larenks olan, boyun muayeneleri klinik N0 olarak değerlendirilen ve çalışma kriterlerine uyan 58 hastada 51 erkek, 7 kadın; ort. yaş 63 yıl; dağılım 21-85 yıl yapılan 70 boyun diseksiyonu çalışmaya dahil edildi. Tümör yeri ve evresi, cerrahinin tipi, patolojik N evresi, patolojik olarak pozitif nodların sayısı ve yeri, ekstrakapsüler yayılım, perinöral yayılım, ameliyat sonrası radyoterapi alıp almadığı, lokal ve bölgesel yineleme, sistemik yayılım ve takip zamanı ile ilgili tüm detaylar kaydedildi. Bulgular: Baş ve boyun yerleşimli yassı hücreli kanseri olan 102 N0 hastanın 99’unda selektif boyun diseksiyonun yapıldığı tespit edildi. Çalışma kriterlerine uyan 58 hastada takip zamanı yaklaşık 23 aydı. Primer tümörün en sık görüldüğü alan larenks bölgesiydi ve hastaların çoğu T2 evresindeydi. Dokuz hastada patolojik olarak pozitif lenf nodu görüldü ve gizli yayılım oranı %13 olarak bulundu, Yineleme oranı %19 olarak tespit edildi. On beş hastada ameliyat sonrası radyoterapi uygulandı. Bölgesel kontrol oranı, patolojik pozitif lenf nodu olan hastalarda daha düşüktü ancak anlamlı bulunmadı. Sonuç: Selektif boyun diseksiyonu, klinik N0 boyunlu hastaların kontrolünde ve evrelendirilmesinde oldukça etkili ve güvenli bir ameliyattır.

References

  • Davidson J, Khan Y, Gilbert R, Birt BD, Balogh J, MacKenzie R. Is selective neck dissection sufficient treatment for the N0/Np+ neck? J Otolaryngol 1997; 26:229-31.
  • Hosal AS, Carrau RL, Johnson JT, Myers EN. Selective neck dissection in the management of the clinically node-negative neck. Laryngoscope 2000;110:2037-40.
  • Pitman KT, Johnson JT, Myers EN. Effectiveness of selective neck dissection for management of the clini- cally negative neck. Arch Otolaryngol Head Neck Surg 1997;123:917-22.
  • Traynor SJ, Cohen JI, Gray J, Andersen PE, Everts EC. Selective neck dissection and the management of the node-positive neck. Am J Surg 1996;172:654-7.
  • Mafee MF, Valvossori GE, Becker M. Imaging of the head and neck. 2nd ed. New York: Thieme Medical Publishers; 1995.
  • Inohara H, Enomoto K, Tomiyama Y, Yoshii T, Osaki Y, Higuchi I, et al. The role of CT and (18)F-FDG PET in managing the neck in node-positive head and neck cancer after chemoradiotherapy. Acta Otolaryngol 2008:1-7.
  • Yamazaki Y, Saitoh M, Notani K, Tei K, Totsuka Y, Takinami S, et al. Assessment of cervical lymph node metastases using FDG-PET in patients with head and neck cancer. Ann Nucl Med 2008;22:177-84.
  • Nahmias C, Carlson ER, Duncan LD, Blodgett TM, Kennedy J, Long MJ, et al. Positron emission tomogra- phy/computerized tomography (PET/CT) scanning for preoperative staging of patients with oral/head and neck cancer. J Oral Maxillofac Surg 2007;65:2524-35.
  • Ferlito A, Silver CE, Rinaldo A. Selective neck dissec- tion (IIA, III): a rational replacement for complete func- tional neck dissection in patients with N0 supraglottic and glottic squamous carcinoma. Laryngoscope 2008; 118:676-9.
  • Clayman GL, Frank DK. Selective neck dissection of anatomically appropriate levels is as efficacious as modified radical neck dissection for elective treat- ment of the clinically negatice neck in patients with squamous cell carcinoma of the upper respiratory and digestive tracts. Arch Otolaryngol Head Neck Surg 1998;124:348-52.
  • Coskun HH, Erisen L, Basut O. Selective neck dissec- tion for clinically N0 neck in laryngeal cancer: is dis- section of level IIb necessary? Otolaryngol Head Neck Surg 2004;131:655-9.
  • Erdağ TK, Karas C, Ikiz AO, Güneri EA, Ceryan K, Sarioğlu S. The incidence of level I metastasis in lar- yngopharyngeal squamous cell carcinoma. [Article in Turkish] Kulak Burun Bogaz Ihtis Derg 2003;11:166-9.
  • Katilmiş H, Öztürkcan S, Özdemir I, Tuna B, Güvenç IA, Özkul Y. Is dissection of level 4 and 5 justified for cN0 laryngeal and hypopharyngeal cancer? Acta Otolaryngol 2007;127:1202-6.
  • Çağli S, Yüce I, Güney E. Is routine inclusion of level IV necessary in neck dissection for clinically N0 supraglottic carcinoma? Otolaryngol Head Neck Sur 2007;136:287-90.
  • Özdek A, Yılmaz T, Saraç S, Turan E, Kaya S. Larenks kanserlerinde tümör lokalizasyonuna göre boyun metastazlarının dağılımı. Kulak Burun Boğaz ve Baş Boyun Cerrahisi Dergisi 1999;7:52-4.
  • Alvi A, Johnson JT. Extracapsular spread in the clini- cally negative neck (N0): implications and outcome. Otolaryngol Head Neck Surg 1996;114:65-70.
  • Byers RM, Clayman GL, McGill D, Andrews T, Kare RP, Roberts DB, et al. Selective neck dissections for squamous carcinoma of the upper aerodigestive tract: patterns of regional failure. Head Neck 1999;21:499-505.
There are 17 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

Fulya Özer This is me

Cem Özer This is me

Alper Nabi Erkan This is me

Haluk Yavuz This is me

Publication Date August 18, 2009
Published in Issue Year 2009 Volume: 19 Issue: 4

Cite

APA Özer, F., Özer, C., Erkan, A. N., Yavuz, H. (2009). N0 boyun tedavisinde selektif boyun diseksiyonunun tedavideki rolü ve etkinliği. The Turkish Journal of Ear Nose and Throat, 19(4), 192-197.
AMA Özer F, Özer C, Erkan AN, Yavuz H. N0 boyun tedavisinde selektif boyun diseksiyonunun tedavideki rolü ve etkinliği. Tr-ENT. August 2009;19(4):192-197.
Chicago Özer, Fulya, Cem Özer, Alper Nabi Erkan, and Haluk Yavuz. “N0 Boyun Tedavisinde Selektif Boyun Diseksiyonunun Tedavideki Rolü Ve etkinliği”. The Turkish Journal of Ear Nose and Throat 19, no. 4 (August 2009): 192-97.
EndNote Özer F, Özer C, Erkan AN, Yavuz H (August 1, 2009) N0 boyun tedavisinde selektif boyun diseksiyonunun tedavideki rolü ve etkinliği. The Turkish Journal of Ear Nose and Throat 19 4 192–197.
IEEE F. Özer, C. Özer, A. N. Erkan, and H. Yavuz, “N0 boyun tedavisinde selektif boyun diseksiyonunun tedavideki rolü ve etkinliği”, Tr-ENT, vol. 19, no. 4, pp. 192–197, 2009.
ISNAD Özer, Fulya et al. “N0 Boyun Tedavisinde Selektif Boyun Diseksiyonunun Tedavideki Rolü Ve etkinliği”. The Turkish Journal of Ear Nose and Throat 19/4 (August 2009), 192-197.
JAMA Özer F, Özer C, Erkan AN, Yavuz H. N0 boyun tedavisinde selektif boyun diseksiyonunun tedavideki rolü ve etkinliği. Tr-ENT. 2009;19:192–197.
MLA Özer, Fulya et al. “N0 Boyun Tedavisinde Selektif Boyun Diseksiyonunun Tedavideki Rolü Ve etkinliği”. The Turkish Journal of Ear Nose and Throat, vol. 19, no. 4, 2009, pp. 192-7.
Vancouver Özer F, Özer C, Erkan AN, Yavuz H. N0 boyun tedavisinde selektif boyun diseksiyonunun tedavideki rolü ve etkinliği. Tr-ENT. 2009;19(4):192-7.