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

Yıl 2009, Cilt: 19 Sayı: 4, 192 - 197, 18.08.2009

Fulya Özer Cem Özer Alper Nabi Erkan Haluk Yavuz

Öz

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.

Anahtar Kelimeler

Head and neck cancer, N0 neck, selective neck dissections

N0 boyun tedavisinde selektif boyun diseksiyonunun tedavideki rolü ve etkinliği

Öz

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.

Anahtar Kelimeler

Baş ve boyun kanseri, N0 boyun, selektif boyun diseksiyonu

Kaynakça

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