舌扁平上皮癌の頸部郭清範囲と後発転移に対する救済率改善の検討

Abstract

Late postoperative cervical metastasis (LCM) greatly influences prognosis in cases such as squamous cell carcinoma of the tongue. Indications and preferred prophylactic neck dissection of the clinically negative neck (N0) in tongue carcinoma remain controversial and non standardized. We studied adequate neck dissection area, focusing on T2N0, T2N1 and T3N0 tongue carcinoma. We retrospectively analyzed surgical efficacy in 61 cases with stage I-T1N0, stage II-T2N0, stage III-T2N1 and T3N0 and stage IV-T2-3 N2b-c. All were treated initially with surgery alone. In 13 T1N0 cases, tumors were removed with a 15-20 mm surgical margin, showing LCM in 2. In 18 T2N0 cases, resected with the same surgical margin, LCM was seen in 9. In 5 T2N1 cases performed with partial tongue resection and radical neck dissection (RND), no LCM was seen. In 3 of 4 T3N0 cases, including level I resection, LCM occurred. In 9 stage IV pull-through cases and RND, LCM ocurred in 2. In 30% (9/30) of stage II LCM, 44.4% (4/9) was salvaged by RND. Five-year cumulative survival in 61 was 71.1%, 87.5% in stage I, 76.8% in stage II, 65.6% in stage III, and 55.4% in stage IV. We concluded that local resection is feasible (1) in T1N0 and early T2N0, (2) local and level I-III neck dissection in late T2N0 and T2N1, (3) local dissection, pull-through technique and level I-IV neck dissection in T3N0 and (4) local dissection, pull-through and level I-V neck dissection in stage IV.