Advantages of Selective Neck Dissection, A 3-Year Follow-up Study

Year 2015, , 141 - 145, 01.05.2015

Şahin Ulu Ela Cömert Necmi Arslan Engin Dursun

https://doi.org/10.5505/abantmedj.2015.87609

Abstract

OBJECTIVE: The main spread of head and neck cancers is through lymphatic system. A physician who will treat this region tumors should keep in mind lymphatic spread.Although there is a consensus for treatment of patients who have palpable lymphadenopathy at neck, the discussion is still ongoing for the treatment of N0 necks. Selective neck dissection is usually performed according to the localization of the primary tumor. It can be performed to both N0 and N + patients. METHODS: In our study, patients who had selective neck dissection due to head and neck malignant tumor and their Lymph node spreads were evaluated along with preoperative -postoperative imaging methods and pathology reports. 3-year follow-up results were analyzed.RESULTS: 3-year survival rate of 45 patients who had selective neck dissection and included in the study was found to be 92%. During 3-year follow-up period, neck recurrence was observed in 4 patients 8.8% . Of these 4 patients, 2 patients were followed up for larynx carcinoma and other 2 patients were followed up for lower lip carcinomas. CONCLUSION: In conclusion, due to the advantages of time and complications the reliability of selective neck dissection increases year after year. We believe that, with larger series of head and neck cancer, super-selective neck dissection will become more widely in the future.

Keywords

Lip tumors, laryngeal tumors, neck dissection

Selektif Boyun Diseksiyonunun Avantajları ve 3 Yıllık Takip Çalışması

Abstract

AMAÇ: Baş- boyun bölgesi kanserlerinin temel yayılımı lenfatik sistem yolu ile olur. Bu bölge tümörlerinin tedavisini yapacak olan bir hekimin lenfatik yayılımı mutlaka göz önünde bulundurması gerekir. Boyunda klinik olarak palpe edilebilen, metastatik lenfadenopatisi olan hastalarda tedavi için fikir birliği sağlanmış olmasına rağmen, N0 boyunlarda tedavi yöntemi hakkında net bir görüş yoktur. Selektif boyun diseksiyonu SBD genellikle primer tümörün lokalizasyonuna göre yapılmaktadır. Hem N0 hem de N+ hastalarda yapılabilmektedir.YÖNTEMLER: Çalışmamızda baş boyun malign tümörü nedeniyle opere edilen 45 hasta ve bu hastalara yapılan 79 selektif boyun diseksiyonu değerlendirildi. SBD yapılan hastaların 3 yıllık takip sonuçları incelendi.BULGULAR: Çalışmaya katılan hastaların 3 yıllık sağkalım oranı %92 olarak bulundu. Ortalama 3 yıllık takiplerde 4 hastada %8,8 boyunda rekürrens görüldü. Hiç bir hastamızda IIb bölgesine metastaz tespit edilmedi. SBD yapılan hastalarımızda daha az komplikasyon gözlendi ve diğer boyun diseksiyonlarına göre daha kısa bir sürede yapıldı. SONUÇ: Sonuç olarak SBD’nun süre ve komplikasyon avantajları nedeniyle her geçen gün daha çok tercih edilen bir yöntem olmaktadır. İleride, baş boyun kanserlerinde geniş serilerle yapılacak çalışmalarla süper SBD’nun daha yaygın hale geleceğine inanmaktayız.

Keywords

Boyun diseksiyonu, selektif boyun diseksiyonu, metastaz

References

• Mira E, Benazzo M, Rossi V, Zanoletti E.. Efficacy of selective lymp node dissection in clinically negative neck. Otolaryngol Head Neck Surgery 2002; 127: 279-283.
• Pellitteri PK, Robbins KT, Neuman T. Expanded application of selective neck dissection with regard to nodal status. Head Neck 1997; 19: 260-5.
• Kowalski LP, Carvalho AL. Feasibility of Supraomohyoid neck dissection in N1 and N2a oral cancer patients. Head Neck Surgery 2002; 24: 921- 924.
• Davidson J, Khan Y, Gilbert R, Birt BD, Balogh J, MacKenzie R. İs selective neck dissection sufficient treatment for the N0 - Np+ neck? The Journal of Otolaryngology 1997; 26: 229-231.
• Shah j P, Candela F, Poddar A. The patterns of cervical lymph node metastases from squamous carcinoma of the oral cavity. Cancer 1990; 66: 109- 113.
• Kolli VR, Datta RV, Orner JB, Hicks WL Jr, Loree TR.. The role of supraomohyoid neck dissection in patients with positive nodes. Arch Otolaryngol Head Neck Surgery 2000; 126: 413-416.
• Medina JE, Byers RM. Supraomohyoid neck dissection: Rationale, indications and surgical technique. Head Neck Surgery 1989; 11: 111-22.
• 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.
• Gourın CG. Is selective neck dissection adequate treatment for node – positive disease? Arch Otolaryngol Head Neck Surgery 2004; 130: 1431- 1434.
• Sivanandan R, Kaplan MJ, Lee KJ, Lebl D, Pinto H, Le QT, Goffinet DR, Fee WE Jr.. Long term results of 100 consequtive comprehensive neck dissection. Arch Otolaryngol Head Neck Surgery 2004; 130: 1369-1373.
• Sivanandan R, Kaplan MJ, Lee KJ, Lebl D, Pinto H, Le QT, Goffinet DR, Fee WE Jr. Posterior triangle metastases of squamos cell carcinoma of the upper aerodigestive tract. The American Journal of Surgery 1993; 166: 395-398.
• Li XM, Wei WI, Guo XF, Yuen PW, Lam LK.. Cervical lymph node metastatic patterns of
• squamos cell carsinomas in the upper aerodigestive tract. The Journal of Otolaryngology and Otology 1996; 110: 937-941.
• Candela FC, Kothari K, Shah JP. Patterns of cervical node metastases from squamous carcinoma of the oropharynx and hypopharyni. Head Neck 1990; 12: 197—203.
• Lohuis PJ, Klop WM, Tan IB, van Den Brekel MW, Hilgers FJ, Balm AJ.. Effectiveness of the therapeutic (N1, N2) selektif neck dissection (levels II to V) in patients with laryngeal squamos cell carcinoma. The American Journal of Surgery 2004;187:295-299.
• Muzaffer K. Therapeutic selective Neck Dissection: A 25 –Year review . Laryngoscope 2003; 113: 1460-1465.
• Park SM, Lee DJ, Chung EJ, Kim JH, Park IS, Lee MJ, Rho YS. Conversion from selective to comprehensive neck dissection: is it necessary for occult nodal metastasis? 5-year observational study. Clin Exp Otorhinolaryngol 2013 Jun;6(2):94-8.
• Chepeha DB, Taylor RJ, Chepeha JC, Teknos TN, Bradford CR, Sharma PK, Terrell JE, Wolf GT. Functional assesment using constant’s shoulder scale after modified radical and selektif neck dissection. Head Neck Surgery 2002; 24: 432-436.
• Lee CH, Huang NC, Chen HC, Chen MK. Minimizing shoulder syndrome with intra-operative spinal accessory nerve monitoring for neck dissection. 2013;33(2):93-6.
• Byers RM, Clayman GL, McGill D, Andrews T, Kare RP, Roberts DB, Goepfert H.. Selektive neck dissections for squamous cell carcinoma of the upper aerodigestive tract: Patterns of regional failure. Head Neck 1999; 21: 499-505.
• Kerrebijn JD, Freeman JL, Irish JC, Witterick IJ, Brown Supraomohyoid neck dissection. Is it diagnostic or therapeutic? Head Neck 1999; 21: 39-42.
• Andersen PE, Warren F, Spiro J, Burningham A, Wong R, Wax MK, Shah JP, Cohen JI. Results of selektif neck dissection in manegement of the node – positive neck. Arch Otolaryngol Head Neck Surgery 2002; 128: 1180-1184.
• Robbins KT, Dhiwakar M, Vieira F, Rao K, Malone J. Efficacy of super-selective neck dissection following chemoradiation for advanced head and neck cancer. Oral Oncol 2012 Nov; 48(11):1185-9.