Radical versus supraomohyoid neck dissection in the treatment of squamous cell carcinoma of the inferior level of the mouth

Revista Brasileira de Otorrinolaringologia

Hospital Heliópolis¹  USP¹  Perez, Ricardo Salinas¹  Dedivitis, Rogério Aparecido¹  Lehn, Carlos Neutzling¹  Rapoport, Abrão¹  Amar, Ali¹  HOSPHEL¹  Rodrigues, Helen Mara¹  Ortellado, Daniel Kanabben¹  Universidade Federal de São Paulo¹ 

关键词: mouth;    key words: neck dissection;    radical;    supraomohyoid.;   

DOI  :  10.1590/S0034-72992007000500009

学科分类：医学（综合）

来源: Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervicofacial

【 摘 要 】

The presence of lymphatic cervical metastases in patients bearing epidermoid carcinoma (or squamous cell carcinoma) of the lower portion of the mouth predicts an unfavorable prognosis. This explains a constant concern and strategy changes in the treatment of the neck with this malignancy. Originally, radical neck dissection was the rule for therapy.1 This approach started to be questioned due to lack of disease control2 and increased knowledge about visceral compartments that justified the preservation of non-lymphatic structures of the neck (jugular vein, spinal nerve and the sternocleidomastoid muscle).3,4 After the 1970s, new studies revealed that lymphatic metastasizing into various neck regions followed a selective pattern according to the site of the primary tumor.5-7 This made it possible to progressively systematize selective neck dissection, where results were similar those obtained from radical neck dissection, although some of the lymphatic chains were not resected.8 These findings enabled physicians to recommend selective neck dissection with oncological safety. Initially, this procedure was used in necks with no metastatic lymph nodes (cN0) and in those cases with lymph node metastases up to 2 cm with no rupture of the capsule (pN1).9-17 These studies underlined our proposition to change the extension of neck dissection for the surgical treatment of necks with clinical metastases (cN1) from squamous cell carcinoma in the lower region of the mouth. We based our proposition on the follow-up of patients and the diagnosis of lymph node recurrence in those anatomical regions not included in the selective procedure. MATERIAL AND METHODA retrospective analysis was made of 460 charts of patients diagnosed with squamous cell carcinoma in the lower region of the mouth. The Research Ethics Committee approved the trial (number 353). Eligibility criteria were as follows: previously untreated patients with squamous cell carcinoma in the lower region of the mouth (tongue, floor of the mouth, retromolar region and the lower gingiva) that underwent radical or selective (supraomohyoid) neck dissection, with a minimum follow-up period of 12 months or until death.18 Patients were classified according to age, sex, site of the primary tumor, and clinical and pathological staging (TNM 2002). The mean age was 54.5 years, the median age was 53 years (Q25-75% = 47 - 62), the minimum age was 22 years and the maximum age was 87years. There were 406 men (88.3%) and 54 women (11.7%), an 8:1 ratio. The tumor sites were the floor of the mouth (180 cases, 39.1%), the tongue (136 cases, 29.6%), the retromolar region (74 cases, 16.1%) and the lower gingiva (70 cases, 15.2%).Staging of the primary tumor was as follows: 14 cases were T1 (3.0%), 157 cases were T2 (34.1%), 146 cases were T3 (31.8%), 138 cases were T4 (30.0%) and five cases were 5 Tx (1.1%). Clinical staging of the neck was as follows: 227 cases were cN0 (49.3%) and 233 cases were cN+ (50.7%), of which 119 cases were N1 (25.9%), 18 cases were N2a (3.9%), 58 cases were N2b (12.6%), 23 cases were N2c (5.0%), 14 cases were N3 (3.0%) and 1

【 授权许可】

Unknown