Neck Dissection for Cervical Lymph Node Metastases from Remote Primary Malignancies

Shogo Shinohara,Masahiro Kikuchi,Shinji Takebayashi,Kiyomi Hamaguchi,Hiroyuki Harada

doi:10.3390/medicina56070343

Abstract

Background and Objectives: Patients with cervical lymph node metastases from remote primary tumours have poor prognoses because of the advanced stage of their cancer. Owing to recent progress in the nonsurgical management of various cancer types, options for surgical treatment to reduce tumour volume are increasing, and may help improve survival rates. For example, neck dissection may be a good option as a definitive therapy for some patients with resectable cervical metastases. We assessed patients who underwent neck dissection with curative intent and discuss the effectiveness of this approach for cervical metastases from remote malignancies. Material and Methods: We retrospectively reviewed the data of 18 patients (10 males and 8 females in an age range of 30–79 years) who underwent neck dissections for neck lymph node metastases from a remote primary tumour between 2010 and 2019. Patient clinical characteristics, preoperative accuracy of positive node localisation using fluorodeoxyglucose positron emission tomography–computed tomography (FDG/PET-CT), and patient survival rates were estimated. Results: Primary sites included ten lungs, two mammary glands, one thymus, one thoracic oesophagus, one stomach, one uterine cervix, one ovary, and one testis per patient. There were 19 levels with FDG/PET-CT positive nodes in 17 out of 18 patients. Conversely, there were 28 pathological positive levels out of 50 dissected levels. The sensitivity, specificity, positive and negative predictive values, and accuracy of FDG-PET/CT in predicting positive nodes were 69%, 88%, 95%, 47%, and 74%, respectively. The three-year overall survival (OS) rate for all patients was 70%. The three-year OS rate of the group with zero or one pathological positive nodes was 81%, which was significantly higher than that of the group with more than two positive nodes (51%) (p = 0.03). Conclusions: Neck dissection for cervical lymph node metastases from remote primary malignancies may improve prognoses, especially considering anticancer agents and radiotherapy advancements.

Highlights

Cervical lymph node metastases from remote primary tumours have poor prognoses because of the advanced stage of the patient’s cancer
We retrospectively review our patients, encountered over a 10 year period, who received neck dissection for curative intent, and discuss the effectiveness of neck dissection for cervical metastases from remote malignancies
Distribution of positive nodes (p+Ns) according to Primary Site

Summary

Introduction

Cervical lymph node metastases from remote primary tumours have poor prognoses because of the advanced stage of the patient’s cancer. Head and neck surgeons will be requested to perform a cytological/pathological examination to assess cervical lymph node swelling for staging of the remote primary tumours. Cytological examination is not enough to assess the primary organ, and a core needle biopsy/open biopsy will be required for immnohistochemical staining or genetic testing. These invasive interventions are for staging, and not with curative intent. Patients with cervical lymph node metastases from remote primary tumours have poor prognoses because of the advanced stage of their cancer.

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Discussion

Conclusion