Oral Skuamöz Hücreli Karsinom Vakalarında Boyun Diseksiyonu: Ne Zaman, Hangi Prosedür?

Öz

Oral bölgede en sık görülen malign tümör skuamöz hücreli karsinom (shk)’dur. Shk’nın en iyi sonuç veren tedavi seçeneği cerrahi tedaviyle birlikte radyoterapi/kemoterapi olarak bilinmektedir. Boyun diseksiyonu (bd) tipine karar verirken TNM sınıflaması göz önünde bulundurulmalıdır. Bu çalışmadaki amaç; oral shk’da boyun diseksiyonu (bd) prosedürlerini tanımlamak ve olgu raporları ile prosedürleri örneklendirmektir. 2016-2019 yılları arasında başvuran ve tedavi edilen 9 oral shk’li hasta sunulmuştur. 7 hastaya tek taraflı elektif subraomohiyoid bd, 1 hastaya tek taraflı tedavi edici modifiye radikal(fonksiyonel) bd, 1 hastaya çift taraflı tedavi edici modifiye radikal (fonksiyonel) bd uygulanmıştır. Doğru endikasyon ile boyun diseksiyonu prosedürlerinin seçimi mikroinvazyon ve metastaz riskini azaltmasının yanı sıra cerrahi sonrası morbiditeyi de azaltmaktadır. Mikroinvazyon riskini ekarte etmek için N0 hastalarda elektif bd, N(+) hastalarda ipsilateral tedavi edici bd ile birlikte kontralateral elektif bd uygulanabilmektedir. Cerrahi morbiditeyi azaltmak için boyun anatomik yapılarının korunması ve oral shk’da sık metastaz görülen boyun düzeylerinin temizlenmesi önem arz etmektedir.

Anahtar Kelimeler

• Skuamöz hücreli karsinom
• boyun diseksiyonu
• mikroinvazyon
• morbidite

Neck dissection in oral scuamous cell carcinoma cases: when, which procedure?

Öz

The most common malignant tumor in the oral region is squamous cell carcinoma (scc). The best treatment option of scc is known as surgical treatment combined with radiotherapy/chemotherapy. When deciding on the type of neck dissection (nd), the TNM classification should be considered. The purpose of this study; to describe nd procedures in oral scc and to illustrate procedures. 9 oral scc patients who were admitted and treated between 2016-2019, were presented. Unilateral elective subraomohyoid nd was performed in 7 patients. Unilateral therapeutic modified radical(functional) nd was performed in one patient. Bilateral therapeutic modified radical(functional) nd was performed in one patient. Choosing neck dissection procedures with the correct indication not only reduces the risk of microinvasion, but also reduces postoperative morbidity. Elective nd is performed in N0 patients to rule out the risk of microinvasion. In N+ patients, ipsilateral therapeutic nd can be combined with contralateral elective nd.

Anahtar Kelimeler

• Squamous cell carcinoma
• neck dissection
• microinvasion
• morbidity

Kaynakça

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