Is Site-Specific Assessment of Neck Nodes Relevant for Neck Dissection

Overview

Journal J Maxillofac Oral Surg

Date 2021 Nov 15

PMID 34776685

Authors

Vinay Singh Yadav

Venkatesh Srinivasa Rao Anehosur

Sahana Adirajaiah

Keerthana Krishnamurthy

Affiliations

Soon will be listed here.

Abstract

Purpose: To highlight the strategy of neck dissection for various subsites of oral squamous cell carcinoma.

Materials & Methodology: Retrospective study of 153 patients with 164 neck dissection was involved between 2010 and 2016. Predictor variables were patient demographics, biopsy reports, imaging assessment and outcome variables were type of neck dissection and reconstruction performed and histological assessment of regional metastasis to the neck in relation to various primary subsites was carried out.

Results: Out of 153 patients, 126 (82.3%) were males and 27 (17.6%) were females with male-to-female ratio being 4.6:1. The mean age among the patients was 49.9 which ranged from 20 to 80 years. Lymph node metastasis was found in 22.6% of 1 and 2 tumors and 77.4% of 3 and 4 tumors. Incidence for gingivobuccal sulcus accounted for 49.6% of primary sites, tongue and floor of the mouth for 15.2%, retromolar trigone for 11.7%, lower alveolus for 8.6%, upper alveolus for 5.9%, lower lip for 3.9%, buccal mucosa for 3.3% and hard palate for 2.6%. Histologically metastasis was seen in level Ib (46%), IIa (33.1%) followed by others. Level V involvement was seen only in 5.5%.

Conclusion: For all subsites for 0 neck, minimum level III clearance should be performed, and for positive neck in RMT region, level IV or level V clearance is warranted. Apart from subsite, other factors to be considered are tumor stage, tumor thickness (DOI) and morphological characteristics of the primary tumor. The role of lymph node metastasis, number, size, extracapsular spread, its proximity and fixity to greater vessels in the neck.

References

Shah J, Candela F, Poddar A . The patterns of cervical lymph node metastases from squamous carcinoma of the oral cavity. Cancer. 1990; 66(1):109-13. DOI: 10.1002/1097-0142(19900701)66:1<109::aid-cncr2820660120>3.0.co;2-a. View

van den Brekel M, Leemans C, Snow G . Assessment and management of lymph node metastases in the neck in head and neck cancer patients. Crit Rev Oncol Hematol. 1996; 22(3):175-82. DOI: 10.1016/1040-8428(96)00191-6. View

Som P . Lymph nodes of the neck. Radiology. 1987; 165(3):593-600. DOI: 10.1148/radiology.165.3.3317494. View

Pandey M, Shukla M, Nithya C . Pattern of lymphatic spread from carcinoma of the buccal mucosa and its implication for less than radical surgery. J Oral Maxillofac Surg. 2010; 69(2):340-5. DOI: 10.1016/j.joms.2010.02.031. View

Lindberg R . Distribution of cervical lymph node metastases from squamous cell carcinoma of the upper respiratory and digestive tracts. Cancer. 1972; 29(6):1446-9. DOI: 10.1002/1097-0142(197206)29:6<1446::aid-cncr2820290604>3.0.co;2-c. View

Snow G, Annyas A, VAN SLOOTEN E, Bartelink H, Hart A . Prognostic factors of neck node metastasis. Clin Otolaryngol Allied Sci. 1982; 7(3):185-92. DOI: 10.1111/j.1365-2273.1982.tb01581.x. View

Warnakulasuriya S . Global epidemiology of oral and oropharyngeal cancer. Oral Oncol. 2008; 45(4-5):309-16. DOI: 10.1016/j.oraloncology.2008.06.002. View

Nithya C, Pandey M, Naik B, Ahamed I . Patterns of cervical metastasis from carcinoma of the oral tongue. World J Surg Oncol. 2003; 1(1):10. PMC: 166158. DOI: 10.1186/1477-7819-1-10. View

Califano L, Zupi A, Massari P, Giardino C . Lymph-node metastasis in squamous cell carcinoma of the lip. A retrospective analysis of 105 cases. Int J Oral Maxillofac Surg. 1994; 23(6 Pt 1):351-5. DOI: 10.1016/s0901-5027(05)80053-0. View

10.

Shah J . Patterns of cervical lymph node metastasis from squamous carcinomas of the upper aerodigestive tract. Am J Surg. 1990; 160(4):405-9. DOI: 10.1016/s0002-9610(05)80554-9. View

11.

Wang Y, Ow T, Myers J . Pathways for cervical metastasis in malignant neoplasms of the head and neck region. Clin Anat. 2011; 25(1):54-71. DOI: 10.1002/ca.21249. View

12.

Narendra H, Tankshali R . Prevalence and pattern of nodal metastasis in pT4 gingivobuccal cancers and its implications for treatment. Indian J Cancer. 2010; 47(3):328-31. DOI: 10.4103/0019-509X.64720. View

13.

Woolgar J . Detailed topography of cervical lymph-note metastases from oral squamous cell carcinoma. Int J Oral Maxillofac Surg. 1997; 26(1):3-9. DOI: 10.1016/s0901-5027(97)80837-5. View

14.

Zhang W, Peng X . Cervical metastases of oral maxillary squamous cell carcinoma: A systematic review and meta-analysis. Head Neck. 2016; 38 Suppl 1:E2335-42. DOI: 10.1002/hed.24274. View

15.

Parkin D, Bray F, Ferlay J, Pisani P . Global cancer statistics, 2002. CA Cancer J Clin. 2005; 55(2):74-108. DOI: 10.3322/canjclin.55.2.74. View

16.

Sharpe D . The pattern of lymph node metastases in intra-oral squamous cell carcinoma. Br J Plast Surg. 1981; 34(1):97-101. DOI: 10.1016/0007-1226(81)90110-7. View