Abstract

All specialists managing a patient suffering head and neck cancer must ask themselves which is the best way to treat the neck. Several types of analysis are performed routinely for defining local, regional and distance extension sites. Cervical nodes have risk of microscopic metastases; this depends on the size and level of tumour invasion which is why routine prophylactic neck dissections are made, even during early stages, because of possible complications and associated morbidity. The use of the sentinel node was thus accepted during the last decade for reducing such probability, even for early tumours of the oral cavity. Salvage surgery involving superselective neck dissection (SSND) for metastasis (in recurrence or persistence after treatment with chemotherapy and/or radiotherapy) of lymph nodes in the neck has increased during recent years. SSND has also been considered useful for managing the neck in cases clinically graded N(0) or N(1) involving patients suffering cancer of the upper digestive tract. As such indication causes controversy and leads to diverging opinions, this article discusses the usefulness of this type of dissection.

Highlights

  • Palabras clave: Disección del cuello; Carcinoma; Neoplasias de Keywords: Neck dissection; carcinoma; Head and neck cabeza y cuello; Biopsia del ganglio linfático centinela (DeCS). neoplasms; Sentinel lymph node biopsy (MeSH)

  • Cervical nodes have risk of microscopic metastases; this depends on the size and level of tumour invasion which is why routine prophylactic neck dissections are made, even during early stages, because of possible complications and associated morbidity

  • The use of the sentinel node was accepted during the last decade for reducing such probability, even for early tumours of the oral cavity

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Summary

The evident effectiveness of superselective neck dissection

Todo especialista que emprende el manejo de un paciente con cáncer de cabeza y cuello, tiene como primer interrogante: ¿Cuál es la mejor manera de tratar el cuello? En consecuencia, se realizan de forma rutinaria múltiples estudios para determinar el compromiso local, regional y a distancia. Todo especialista que emprende el manejo de un paciente con cáncer de cabeza y cuello, tiene como primer interrogante: ¿Cuál es la mejor manera de tratar el cuello? Adicionalmente, en los ganglios cervicales existe el riesgo de metástasis microscópicas, dependiente del tamaño y del nivel de invasión tumoral; por lo que rutinariamente se realizan disecciones profilácticas de cuello, incluso en estadios tempranos, existiendo siempre la probabilidad de complicación y morbilidad asociada. En la última década se aceptó el uso del ganglio centinela con la intención de disminuir dicha probabilidad, incluso para tumores tempranos de la cavidad oral. Incluso se plantea la utilidad de este procedimiento para el manejo del cuello en casos N(0) o N(1), de pacientes con cáncer del tubo digestivo superior. Debido a que este planteamiento causa controversia y opiniones divergentes, en este artículo se discute la utilidad de este tipo de disecciones

Summary
De lo radical a lo superselectivo
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