Hao Wu1,2,3, Xue-Hui Sun2, Wen-Ting Hu1,2, Ling Zhang3,4,5. 1. Weifang Medical University, College of Stomatology Weifang 261000, China. 2. Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Weifang Medical University Weifang 261000, China. 3. Department of Oral Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine Shanghai 200011, China. 4. National Clinical Research Center for Oral Diseases Shanghai 200011, China. 5. Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology Shanghai 200011, China.
Abstract
PURPOSE: To identify the significance of level IIb neck dissection for patients with clinically node-negative oral squamous cell carcinoma (OSCC). METHODS: A retrospective study was conducted with 203 patients with OSCC with no palpable lymph nodes in neck admitted to the Department of Oral Maxillofacial-Head and Neck Oncology from January 2012 through December 2014. After the diagnostic evaluations, all patients underwent wide local dissection and periodic supraomohyoid neck dissection (SOHND). In total, 115 patients underwent SOHND with IIb lymph node dissection, and 88 patients underwent elective SOHND without IIb lymph node dissection. The incidence of level IIb lymph node metastasis was evaluated by pathological and immunohistological analyses. The results were analyzed with independent sample t-tests. The incidence of complications (mainly scapular syndrome) and IIb lymph node metastasis rate (mainly for the preserving IIb group) were analyzed. RESULTS: In total, 7 (6.09%) of the 115 patients who underwent SOHND had level IIb lymph nodes involvement. After 3 years of follow-up, 83 (72.17%) patients who underwent SOHND had different degrees of scapular syndrome, and 27 (32.53%) patients who underwent SOHND improved through rehabilitation training but did not fully recover. Four (4.55%) patients who underwent elective SOHND (preserving IIb) developed scapular syndrome and recovered through rehabilitation after surgery. The 3-year overall survival rate of the 115 patients was 86.09%, and the 3-year overall survival rate of the 88 patients who underwent elective SOHND (preserving IIb) was 84.09%. There were no significant differences between the two groups (P > 0.05). CONCLUSION: Patients with clinically N0 OSCC have a low rate of level IIb lymph node metastasis. Level IIb lymph nodes resection are not necessary during SOHND, which thereby protects the accessory nerve and its branches from damage and improves patient quality of life. AJTR
PURPOSE: To identify the significance of level IIb neck dissection for patients with clinically node-negative oral squamous cell carcinoma (OSCC). METHODS: A retrospective study was conducted with 203 patients with OSCC with no palpable lymph nodes in neck admitted to the Department of Oral Maxillofacial-Head and Neck Oncology from January 2012 through December 2014. After the diagnostic evaluations, all patients underwent wide local dissection and periodic supraomohyoid neck dissection (SOHND). In total, 115 patients underwent SOHND with IIb lymph node dissection, and 88 patients underwent elective SOHND without IIb lymph node dissection. The incidence of level IIb lymph node metastasis was evaluated by pathological and immunohistological analyses. The results were analyzed with independent sample t-tests. The incidence of complications (mainly scapular syndrome) and IIb lymph node metastasis rate (mainly for the preserving IIb group) were analyzed. RESULTS: In total, 7 (6.09%) of the 115 patients who underwent SOHND had level IIb lymph nodes involvement. After 3 years of follow-up, 83 (72.17%) patients who underwent SOHND had different degrees of scapular syndrome, and 27 (32.53%) patients who underwent SOHND improved through rehabilitation training but did not fully recover. Four (4.55%) patients who underwent elective SOHND (preserving IIb) developed scapular syndrome and recovered through rehabilitation after surgery. The 3-year overall survival rate of the 115 patients was 86.09%, and the 3-year overall survival rate of the 88 patients who underwent elective SOHND (preserving IIb) was 84.09%. There were no significant differences between the two groups (P > 0.05). CONCLUSION:Patients with clinically N0 OSCC have a low rate of level IIb lymph node metastasis. Level IIb lymph nodes resection are not necessary during SOHND, which thereby protects the accessory nerve and its branches from damage and improves patient quality of life. AJTR
Authors: Yogen P Chheda; Sundaram K Pillai; Devendra G Parikh; Nandy Dipayan; Shakuntala V Shah; Gupta Alaknanda Journal: Indian J Surg Oncol Date: 2014-11-13