Oral Kavite Kanserlerinde Submandibular Gland İnvazyonu; Bezi Gerçekten Almalı mıyız?

Öz

Amaç: Oral kavite kanserleri tedavisinde primer tümörün rezeksiyonu ve boyun diseksiyonu halen en etkin tedavi olark kabul görmektedir. Boyun diseksiyonu sırasında submandibuler glandın eksizyonu rutin olarak yapılmaktadır. Çalışmanın amacı oral kavite kanseri nedeni ile tedavi edilen hastaların evreleri, risk faktörleri ve submandibuler gland metastaz insidansı açısından gözden geçirilmesi ve bu hasta grubunda submandibuler glandın korunup korunamayacağının tartışılmasıdır.Gereç ve Yöntemler: Çalışma Akdeniz Üniversitesi Tıp Fakültesi KBB ve Baş-Boyun Cerrahisi kliniğinde 2014-2019 yılları arasında, oral kavite yassı hücreli karsinom tanısı alıp tedavi edilen hastaların verilerinin retrospektif incelenmesi ile gerçekleştirildi.Bulgular: Çalışmaya dahil edilen 44 hastanın 26’sı erkek, 18’i kadındı. Toplam 57 boyun diseksiyonu uygulanmıştır. İncelenen 57 submandibuler glandın sadece 1 tanesinde %2.27 tümör invazyonu izlendi. Ağız tabanına lokalize tümörün bu hastada submandibuler glandı direkt yayılım yolu ile invaze ettiği görüldü.Sonuç: Tedavi planlanırken, tümör konumuna ve şüpheli seviye I metastazına göre seçilmiş OCC'li hastalarda SMG korunabilir

Anahtar Kelimeler

• Oral kavite kanseri, Metastaz, Baş-boyun kanseri

Submandibular Gland Invasion in Oral Cavity Cancers: Should We Really Remove the Gland? Oral Kavite Kanserlerinde Submandibular Gland İnvazyonu; Bezi Gerçekten Almalı mıyız?

Abstract

Objective: Neck dissection and resection of the primary tumor are still the most effective treatments for oral cavity cancer OCC . The excision of the submandibular gland is routinely performed during neck dissection. The present study aimed to review the stages, risk factors, and incidence of submandibular gland metastases in patients treated for OCC and discuss whether the submandibular glands could be preserved in this patient group.Material and Methods: This study was performed retrospectively with the data of patients diagnosed and treated with oral cavity squamous cell carcinoma at the Otorhinolaryngology and Head and Neck Surgery Department of Akdeniz University School of Medicine between 2014 and 2019. Results: Of the 44 patients included in the study, 26 were male. A total of 57 neck dissections were performed. Tumor invasion was observed in only 1 2.27% of 57 submandibular glands. The tumor localized to the floor of the mouth invaded the submandibular gland by direct invasion.Conclusion: SMG can be preserved in selected patients with OCC according to the tumor location and suspected level I metastasis when planning treatment

Keywords

• Oral cavity cancer, Metastasis, Head and neck cancer

Kaynakça

1. Carvalho AL, Singh B, Spiro RH, Kowalski LP, Shah JP. Cancer of the oral cavity: A comparison between institutions in a developing and a developed nation. Head Neck 2004; 26:31-8.
2. Okada Y, Mataga I, Katagiri M, Ishii K. An analysis of cervical lymph nodes metastasis in oral squamous cell carcinoma. Relationship between grade of histopathological malignancy and lymph nodes metastasis. Int J Oral Maxillofac Surg 2003; 32(3):284-8.
3. Malgonde MS, Kumar M. Practicability of submandibular gland in squamous cell carcinomas of oral cavity. Indian J Otolaryngol Head Neck Surg 2015; 67 Suppl 1:138-40.
4. Panda NK, Patro SK, Bakshi J, Verma RK, Das A, Chatterjee D. Metastasis to submandibular glands in oral cavity cancers: Can we preserve the gland safely? Auris Nasus Larynx 2015; 42(4):322-5.
5. Jaguar GC, Lima EN, Kowalski LP, Pellizon AC, Carvalho AL, Alves FA. Impact of submandibular gland excision on salivary gland function in head and neck cancer patients. Oral Oncol 2010; 46:349-54.
6. Ebrahim AK, Loock JW, Afrogheh A, Hille J. Is it oncologically safe to leave the ipsilateral submandibular gland during neck dissection for head and neck squamous cell carcinoma? J Laryngol Otol 2011; 125(8):837-40.
7. Yajima M, Minimura T, Nebasih S, Sunada O, Tamura M, Kurashina K, Takeda S, Kotani A, Yamazaki T. Clinicostatistical study on the cases for radical neck dissection in of squamous cell carcinomas of oral cavity. Jpn J Oral Maxillofac Surg 1989; 35:647-54.
8. Nakayama A, Ogawa A, Fukuta Y, Kudo K. Relation between lymphatic vessel diameter and clinicopathologic parameters in squamous cell carcinomas of oral region. Cancer 1999; 15:200-6.

9. Woolgar JA. Histological distribution of cervical lymph node metastases from intraoral/oropharyngeal squamous cell carcinomas. Br J Oral Maxillofac Surg 1999; 37(3):175-80.
10. Subramaniam N, Balasubramanian D, Reddy R, Rathod P, Murthy S, Vidhyadharan S, Thankappan K, Iyer S. Determinants of level Ib involvement in oral squamous cell carcinoma and implications for submandibular gland- sparing neck dissection. Int J Oral Maxillofac Surg 2018; 47(12):1507-10.
11. Chen TC, Lo WC, Ko JY, Lou PJ, Yang TL, Wang CP. Rare involvement of submandibular gland by oral squamous cell carcinoma. Head Neck 2009; 31(7):877-81.
12. Razfar A, Walvekar RR, Melkane A, Johnson JT, Myers EN. Incidence and patterns of regional metastasis in early oral squamous cell cancers: Feasibility of submandibular gland preservation. Head Neck 2009; 31(12):1619-23.
13. Spiegel JH, Brys AK, Bhakti A, Singer MI. Metastasis to the submandibular gland in head and neck carcinomas. Head Neck 2004; 26(12):1064-8.
14. Cakir Cetin A, Dogan E, Ozay H, Kumus O, Erdag TK, Karabay N, Sarioglu S, Ikiz AO. Submandibular gland invasion and feasibility of gland-sparing neck dissection in oral cavity carcinoma. J Laryngol Otol 2018; 132(5):446- 51.
15. Rouviere H, Tobies MJ. Trans: Anatomy of the human lymphatic system. Ann Arbor: Edwards Brothers, 1938. pp. 86-8.
16. Fives C, Feeley L, Sadadcharam M, O’Leary G, Sheahan P. Incidence of intraglandular lymph nodes within submandibular gland, and involvement by floor of mouth cancer. Eur Arch Otorhinolaryngol 2017; 274(1):461-6.
17. Byeon HK, Lim YC, Koo BS, Choi EC. Metastasis to the submandibular gland in oral cavity squamous cell carcinomas: Pathologic analysis. Acta Otolaryngol 2009; 129(1):96-100.
18. Basaran B, Ulusan M, Orhan KS, Gunes S, Suoglu Y. Is it necessary to remove submandibular glands in squamous cell carcinomas of the oral cavity? Acta Otorhinolaryngol Ital 2013; 33(2):88-92.
19. Dundar Y, Mandle Q, Raza SN, Lin HS, Cramer J, Hotaling JM. Submandibular Gland Invasion by Oral Cavity Cancers: A Systematic Review. Otolaryngol Head Neck Surg 2019; 161(2):227-34.