Ipsilateral Radical Neck Dissection Research Articles

Cost for treatment and follow-up of thyroid cancer increases according to the severity of disease.

The aim of this study was to provide an analysis of thyroid cancer-related health care costs over a 5-year period, according to the extent of thyroid surgery. The study included 33 patients from our institutional database who underwent thyroid cancer surgery in 2010. Patients were divided into four groups based on surgical extent: (1) hemithyroidectomy, (2) total thyroidectomy, (3) total thyroidectomy with ipsilateral radical neck dissection, and (4) total thyroidectomy with bilateral radical neck dissection and mediastinal dissection. Costs for admission and outpatient follow-up for 5 years were analyzed. Costs for outpatient follow-up and admission, and overall cost increased with increasing stage of disease and increasing extent of thyroid surgery. Patients who underwent only hemithyroidectomy had the lowest costs for outpatient follow-up and admission, as well as the lowest overall cost. Over the 5-year follow-up period, surgery performed at an early disease stage was the most cost-effective.

Complication versus Radicality in Papillary Thyroid Cancer Surgery: How to Keep the Balance?

Background: Controversy exists over the extent of surgical treatment of papillary thyroid cancer.Reoperations may carry a significant risk of surgical complications. The aim of this study is to investigate the complications following surgical treatment of thyroid cancer and the association between the extent of surgery and complication rates. Methods: A total of 196 patients with papillary thyroid cancer were retrospectively reviewed to identify extent of surgery and associated complications, between 2009 and 2018 atSouth Egypt Cancer Institute Assiut University. Results: Primary procedures included less-than-total thyroidectomy (near total thyroidectomy in 5.1%, subtotal thyroidectomy in 4.1%, thyroid lobectomy in 3.1%) and total thyroidectomy in 87.8% (18.9% of them are completion thyroidectomy). No lymph nodes dissection was done in 10.7%, Berry picking in 6.1%, central compartment neck dissection in 41.8%, central compartment neck dissection with modified ipsilateral radical neck dissection in 12.2%, central compartment neck dissection with modified bilateral radical neck dissection in 26.0%, central compartment dissection with both modified bilateral radical neck dissection and superior mediastinal lymph node dissection 3.1%. The most common surgical complication were transient hypoparathyroidism (16.7% - 45.8%) and 2.0% permanent, transient vocal cord palsy (7.3% - 16.7%), and 3.9% permanent, hematoma 1.5%, seroma 7.1% and chyle fistula in 2.6% of patients. Conclusion: Thyroid cancer surgeries are safe. The transient complication rates of hypoparathyroidism increased significantly with increasing the extent of surgery.

Craniofacial resection and reconstruction in patients with recurrent cancer involving the craniomaxillofacial region

Purpose Head and neck tumors that involve the craniomaxillofacial region are classified as stage IVb disease and are clinically challenging. In this study, the outcomes of craniofacial resection and craniofacial reconstruction in patients with recurrent malignant tumors involving the craniomaxillofacial region were evaluated. Patients and Methods This retrospective observational study was conducted from January 2008 to August 2015. Data collected for each patient included age, gender, tumor site, initial treatment, craniofacial resection, reconstruction flaps and complications after craniofacial resection, adjuvant treatment, and reported outcomes of craniofacial resection and craniofacial reconstruction. The χ2 test in SPSS was used to analyze the data. Results Twenty-four patients with recurrent malignant tumors involving the craniomaxillofacial region were identified who had undergone craniofacial resection at the Center of Craniomaxillofacial Surgery of Sun Yat-sen University (Guangzhou, Guangdong, China). The study population was comprised of 24 patients (15 men and 9 women; age range, 21 to 73 yr) with recurrent tumors (58.3% with squamous cell carcinoma [SCC], 41.7% with sarcoma [SA]) involving the craniomaxillofacial region who underwent craniofacial resection. Craniofacial resection consisted of orbital exenteration and maxillotomy; anterior skull base surgery, facial resection, and mandibulotomy; or ipsilateral radical neck dissection. The resultant craniomaxillofacial defects were reconstructed using extended vertical lower trapezius island myocutaneous flaps (TIMFs), temporalis myofascial flaps, or submental flaps. All patients with recurrent malignant tumor involving the craniomaxillofacial region underwent gross total resection of the tumor; 22 patients underwent craniofacial reconstruction. There were no major surgical complications. Minor flap failure and wound dehiscence in the donor site occurred in 4 patients. The follow-up period ranged from 8 to 36 months. Seven patients in the SCC group and 7 in the SA group were alive with no evidence of disease (AND), 3 in the SCC group and 2 in the SA group were alive with disease (AWD), and 4 in the SCC and 1 in the SA group died of the disease (DOD) after local recurrence or distant metastases at 8 to 18 months. There were no statistical differences among the AND, AWD, and DOD groups. Conclusions Craniofacial resection remains an effective salvage treatment for patients with recurrent SCC and SA involving the craniomaxillofacial region. The extended vertical lower TIMF is a large, simple, and reliable flap for reconstructing major defects after a craniofacial resection.

Successful multimodal treatment of intraoral salivary duct carcinoma in a patient with multiple lymph node metastases: a case report

BackgroundSalivary duct carcinoma (SDC) is a high-grade salivary gland malignancy that is associated with an aggressive clinical behavior and poor prognosis. Herein, we report on a long surviving case of SDC of the minor salivary gland with multiple lymph node metastases (LNMs).Case presentationAn 83-year-old woman presented with a history of lymphadenopathy in the right side of the neck and recent onset and rapid growth of a mass in the right buccal region. Clinical examinations and biopsy findings were suggestive of a salivary gland malignant tumor with regional LNMs. The patient was treated with neoadjuvant chemotherapy. Tumor excision and ipsilateral radical neck dissection were performed, followed by adjuvant chemoradiotherapy. Postoperative histological examination revealed a tumor with irregular nests of atypical ductal epithelial cells, a cribriform growth pattern, and comedo-like central necrosis that lead to a final diagnosis of SDC. LNMs were observed in six lymph nodes of the right side of the neck. The patient underwent postoperative chemotherapy using single-agent cisplatin that was administered concurrently with radiotherapy (total, 65 Gy). There was no evidence of local recurrence or distant metastasis for >6 years.ConclusionsAlthough available data on treatment modalities for SDC remain limited, multimodal therapy may contribute to improved clinical outcomes in patients with advanced intraoral SDC.

Craniofacial Resection and Reconstruction in Patients With Recurrent Cancer Involving the Craniomaxillofacial Region

Head and neck tumors that involve the craniomaxillofacial region are classified as stage IVb disease and are clinically challenging. In this study, the outcomes of craniofacial resection and craniofacial reconstruction in patients with recurrent malignant tumors involving the craniomaxillofacial region were evaluated. This retrospective observational study was conducted from January 2008 to August 2015. Data collected for each patient included age, gender, tumor site, initial treatment, craniofacial resection, reconstruction flaps and complications after craniofacial resection, adjuvant treatment, and reported outcomes of craniofacial resection and craniofacial reconstruction. The χ2 test in SPSS was used to analyze the data. Twenty-four patients with recurrent malignant tumors involving the craniomaxillofacial region were identified who had undergone craniofacial resection at the Center of Craniomaxillofacial Surgery of Sun Yat-sen University (Guangzhou, Guangdong, China). The study population was comprised of 24 patients (15 men and 9 women; age range, 21 to 73yr) with recurrent tumors (58.3% with squamous cell carcinoma [SCC], 41.7% with sarcoma [SA]) involving the craniomaxillofacial region who underwent craniofacial resection. Craniofacial resection consisted of orbital exenteration and maxillotomy; anterior skull base surgery, facial resection, and mandibulotomy; or ipsilateral radical neck dissection. The resultant craniomaxillofacial defects were reconstructed using extended vertical lower trapezius island myocutaneous flaps (TIMFs), temporalis myofascial flaps, or submental flaps. All patients with recurrent malignant tumor involving the craniomaxillofacial region underwent gross total resection of the tumor; 22 patients underwent craniofacial reconstruction. There were no major surgical complications. Minor flap failure and wound dehiscence in the donor site occurred in 4 patients. The follow-up period ranged from 8 to 36months. Seven patients in the SCC group and 7 in the SA group were alive with no evidence of disease (AND), 3 in the SCC group and 2 in the SA group were alive with disease (AWD), and 4 in the SCC and 1 in the SA group died of the disease (DOD) after local recurrence or distant metastases at 8 to 18months. There were no statistical differences among the AND, AWD, and DOD groups. Craniofacial resection remains an effective salvage treatment for patients with recurrent SCC and SA involving the craniomaxillofacial region. The extended vertical lower TIMF is a large, simple, and reliable flap for reconstructing major defects after a craniofacial resection.

Reconstruction of full-thickness cheek defects with a folded extended supraclavicular fasciocutaneous island flap following ablation of advanced oral cancer.

The aim of the present clinical study was to evaluate the feasibility of a folded extended supraclavicular fasciocutaneous island flap (SFIF) for full-thickness cheek defect reconstruction following ablative oral cancer surgery. The nine patients with advanced squamous cell carcinoma of the buccal mucosa were six men and three women, with a mean age of 60.8 years. All patients were treated with surgery including ipsilateral radical neck dissection. A folded extended SFIF with a skin paddle ranging between 6 × (6 + 5) cm and 7 × (10 + 9) cm were used to reconstruct the full-thickness cheek defects. One minor flap failure and one wound dehiscence in donor site occurred, but all flaps survived, and there was no major complication in any patient. All patients were able to receive all of their nutrition orally and had normal speech. The patients were followed-up for 9-28 months; six patients were living with no evidence of disease, two was living with disease, and one died of local recurrence. The folded extended SFIF to reconstruct full-thickness cheek defects is reliable and an excellent alternative to other options for patients who have full-thickness defect of the cheek.

「血管内手術の現状と今後の展望」 末梢動脈閉塞，頸動脈に対する血管内手術

In the last decade, the therapeutic strategy for patients with peripheral arterial disease (PAD) has changed markedly after the introduction of endovascular treatment and surgical approaches. In particular, endovascular treatment of iliac occlusive disease is an established treatment modality, although the treatment of infrainguinal lesions remains controversial. The trans-Atlantic Inter-Society Consensus II (TASCII) document of 2007 recommended endovascular treatment in patients with TASCII types A and B lesions and surgical bypass in patients with TASCII types C and D lesions. Most patients with critical limb ischemia (CLI) are in poor general condition, and the goal of revascularization in CLI is not only limb salvage but preservation of life. Currently, bypass surgery is the optimal revascularization procedure for bypass-applicable CLI patients. Improvements in endovascular treatment and expansion of its indication may apply especially to CLI patients who are in poor general condition. Carotid disease is an important cause of stroke and may cause 10-20% of all ischemic strokes. The choice of revascularization strategy in tese cases should be based on the surgical risk profile of the patient and the institution′s expertise. Carotid artery stenting is particularly beneficial for patients at high surgical risk, e.g. surgically inaccessible lesions, radiation-induced carotid stenosis, prior ipsilateral radical neck dissection, and prior carotid endarterectomy. Results of medical treatment continue to improve, but there is still the need for more experience which will aid in establishing treatment strategies for severe carotid disease.

Simultaneous Metastatic Papillary Thyroid Carcinoma and Carcinoid of the Small Intestine in the Cervical Lymph Node Group

Malignancies, primary or metastatic, and infections are the main causative factors that should be included in the differential diagnosis of cervical adenopathy. We present a 56-year-old woman who was admitted to our department because of a supraclavicular mass. A neck dissection was performed and two different masses were excised. The histopathological examination showed that the larger mass (measuring 5 cm) was a block of lymph nodes with metastatic papillary carcinoma of the thyroid. In the adjacent fibroadipose tissue, two lymph nodes with metastatic carcinoid tumor were found. The smaller mass (measuring 2 cm) was a lymph node with metastatic carcinoid tumor. The patient underwent total thyroidectomy with ipsilateral radical neck dissection. Histopatological examination of the thyroid gland showed a lesion of papillary carcinoma, measuring 0.6 cm. No further lesions of carcinoid were found. To our knowledge, this is the first report of a coexistence of metastatic papillary thyroid carcinoma and intestinal carcinoid tumor in cervical lymph nodes.

頸部リンパ節結核をともなった軟口蓋部上皮筋上皮癌の1例

We present a rare case of epithelial-myoepithelial carcinoma (EMC) arising in right side of the soft palate that was accompanied by cervical lymph node tuberculosis.A 72-year-old woman was referred to our hospital because of swelling of the right side of the soft palate. Intraoral examination revealed a submucosal mass lesion measuring 14 × 15mm in the soft palate. Contrast enhanced computed tomography showed a mass on the soft palate and cervical lymph node enlargement with ring enhancement. Magnetic resonance imaging and ultrasonography also revealed cervical lymphadenopathy. Fluorodeoxyglucose positron emission tomography (FDG-PET) showed intense focal FDG uptake in the enlarged lymph nodes, but not in the soft palate. Before surgery, the soft palate lesion underwent a biopsy, and the histopathological diagnosis was EMC. Thus, the enlarged cervical lymph nodes were diagnosed as EMC metastasis. Tumor resection of the soft palate and ipsilateral radical neck dissection were performed. Postoperative histopathological examination revealed EMC of the right soft palate and cervical lymph node tuberculosis. After surgery, antituberculous agents were administered to treat cervical lymph node tuberculosis.

Carcinoma ex pleomorphic adenoma of the submandibular gland: report of a case with an unusual malignant component of clear cell squamous cell carcinoma

A large carcinoma ex pleomorphic adenoma (CXPA) with regional lymph node metastasis occurred in the left submandibular gland of a 64-year-old man. Initially, the patient underwent tumor extirpation and ipsilateral radical neck dissection. Histologic examination revealed the malignant component of CXPA was clear cell squamous cell carcinoma (SCC), which is quite uncommon in head and neck region. In the metastatic regional lymph nodes, aggregates of clear cells were observed. To the best of our knowledge, this is the first case of CXPA of which the malignant component is clear cell SCC. Four months after the postoperative radiotherapy, delayed regional metastasis became evident in the contralateral side of the neck. Radical neck dissection was carried out, and, microscopically, moderately differentiated SCC was identified. The patient recovered well and remained free of disease for 29 months after the second surgery.

Why carotid endarterectomy is method of choice in treatment of carotid stenosis

Procedures used in treatment of carotid stenosis are endarterectomy, PTA with stent implantation, resection with graft interposition and by-pass procedure. Segmental lesions are found more often and treated by the first two mentioned procedures. In case of longer lesions and extension to the greater part of the common carotid artery, the other two procedures are performed. For the past few years, the main dilemma has been whether to perform carotid endarterectomy or PTA with stent implantation. Both early and long-term results speak in favour of carotid endarterectomy, regardless of an increased number of PTA and carotid stenting. At the same time, PTA and carotid stenting are more expensive procedures. Both methods have their defined and important roles in treatment of segmental occlusive carotid lesions. Severe cardiac, pulmonary and renal conditions, which increase the risk of general anaesthesia, are not an absolute indication for PTA and stenting, since endarterectomy can be done in regional anaesthesia. Main indications for PTA with stent implantation are: surgically inaccessible lesions (at or above C2; or subclavian); radiation-induced carotid stenosis; prior ipsilateral radical neck dissection; prior carotid endarterectomy (restenosis).

Dermatofibrosarcoma Protuberans of Scalp With Cervical Lymph Node Metastasis

Dermatofibrosarcoma protuberans (DFSP) is an uncommon, slow growing and locally aggressive tumor of the skin with a high rate of recurrence even after supposedly wide excision. The reports of regional lymph node metastasis and distant metastasis are very rare. Because of the extreme rarity of these cases with metastasis, the experience with management of such patients is very limited. A case of recurrent DFSP of scalp, with metastasis to the regional lymph nodes, in a 17-year-old boy is reported here. This is the second case of DFSP involving scalp and 16th case of DFSP of all sites metastasizing to the regional lymph nodes reported in literature. The patient was treated with wide excision of the lesion and ipsilateral radical neck dissection (including excision of overlying involved skin).

口腔へん平上皮癌における対側頚部リンパ節転移の検討

The prognosis of patients who have oral cancer with contralateral neck lymph node metastasis (CLNM) is poor. In this study, we retrospectively evaluated the incidence of CLNM and conditions associated with the occurrence of CLNM.We reviewed the clinical records of 180 patients who had untreated squamous cell carcinoma that occurred unilaterally (except between the canines) in the oral and maxillofacial region. The patients were treated at our hospital between 1985 and 1999. A total of 29 patients had CLNM (16.1%). All of these patients had ipsilateral neck lymph node metastasis, and there was a trend toward a high prevalence of multiple node involvement. CLNM occurred in the patients with T 2-T 4 tongue cancer and with advanced (T 4) cancer in other regions. Four of the 29 patients with CLNM had simultaneous recurrence at primary sites and three of them had undergone ipsilateral radical neck dissection at initial treatment.Our results suggest that patients with T 4 tumors or T 2-T 4 tongue tumors have a high risk of CLNM. Furthermore, patients with primary tumor recurrence should be closely observed for CLNM if ipsilateral neck dissection had previously been performed.

Strategy of neck dissection in parotid cancer

We conducted definitive surgery on 45 patients with untreated primary parotid cancer from 1975 to 1995, and evaluated methods of neck dissection and results of treatment. All 14 with clinical neck lymph node metastasis underwent ipsilateral radical neck dissection and only 1 developed neck lymph node recurrence at the peripheral dissected site. Of 31 patients without clinical neck lymph node metastasis, 27 of 19 of 36 with high-grade malignancy and 12 of 24 with T3 or T4 did not undergo prophylactic neck dissection and developed latent neck lymph node metastasis in 2 cases (7.4%). Whereas in most cases we achieved good control of the primary site but neck lymph node recurrences occurred, recurrent sites were observed all around the ipsilateral neck and prognosis were very poor if neck dissection was conducted as secondary treatment. Although histopathological diagnosis was considered feasible for predicting occult neck lymph node metastasis, correct diagnostic with fine needle aspiration cytology revealed only 21.8%. Pathological positive lymph nodes in 15 patients who underwent neck dissection were detected all over (level I to V) the ipsilateral neck and the recurrent positive rate at level II was 100%. Based on the above results, we conclude that (1) in cases with neck lymph node metastasis in preoperative evaluation, ipsilateral radical neck dissection is mandated, and (2) in cases without neck lymph node metastasis, prophylactic neck dissection is not usually needed. When pathological results of frozen section from intraoperative jugulodigastric nodal sampling are positive, ipsilateral radical neck dissection is mandated.

へん摘により原発巣の判明したオカルト癌例

We report the case of an occult tonsil carcinoma diagnosed only after a tonsillectomy. A 55 year-old man with upper and midjugular lymph node metastases from an unknown primary tumor was referred to our hospital for treament. The search for the primary tumor required panendoscopy of the upper aerodigestive tract, with biopsies of suspicious lesions at the level of nasopharynx and tonsils, which yielded no detectable primary site. The patient then underwent an ipsilateral radical neck dissection and tonsillectomy. Subsequent histopathologic examination of the whole tonsil specimen revealed an occult tonsil carcinoma in one of the crypts.We conclude that an ipsilateral tonsillectomy is the only reliable screening method to rule out an occult malignancy of the tonsil, and should be performed in patients with upper or mid jugular lymph node metastases due to an unknown primary tumor.

VENOUS DRAINAGE OF FREE FLAPS FOLLOWING RADICAL NECK DISSECTION

Large tissue defects may occur following head and neck surgery. When combined with ipsilateral radical neck dissection the venous drainage of a free flap used to cover the defect may be compromised. Twelve patients having radical neck dissections underwent on-table venography to study the pattern of venous drainage of these flaps. The predominant drainage pattern is initially in a cephalic direction, then across the midline and finally in a caudal direction on the contralateral side of the neck. Venous drainage to the contralateral side of the neck may be a determinant of flap survival. In order to facilitate venous drainage following free flap procedures, patients should be positioned so that the contralateral internal jugular vein is not compressed. Drains should be placed caudal to the microvascular anastomoses in order to minimize interference with the cephalic direction of venous drainage. Any patient having a radical neck dissection requiring a central venous catheter should have it placed ipsilateral to the neck dissection. Thrombosis around a contralaterally placed cannula may significantly increase head and neck venous pressure.

Aberrant central venous catheter complicating radical neck dissection

Abnormal migration of central venous catheters is especially common in the case of long lines inserted via the antecubital fossa. A case is described of internal jugular vein migration of a central venous catheter complicating an ipsilateral radical neck dissection.

Second radical neck dissection

We report a series of 96 patients (62 men and 34 women) undergoing a second radical neck dissection for enlarged contralateral cervical nodes after primary treatment of a squamous cell carcinoma of the head and neck, including an ipsilateral radical neck dissection. The proportion of patients requiring a second later neck dissection varied from 0% for tumours of the nasopharynx, nasal cavity and paranasal sinuses, to 5% for tumours of the hypopharynx. The incidence of second neck dissection was not determined by the original T stage of the primary tumour, but patients with enlarged nodes at presentation were 5 times more likely to need a second neck dissection than those with no palpable nodes at presentation. Also, patients with a poorly differentiated tumour were twice as likely to need a second neck dissection as those with a well differentiated tumour. The overall 5-year survival after second neck dissection was 35% and the perioperative mortality 1.92%. Significant factors predicting survival after a second neck dissection were the time to recurrence, the clinical neck node status at recurrence, the number of histologically invaded nodes in the neck and the presence of extra-nodal disease.

Use of the inferiorly based platysma flap for hypopharyngeal reconstruction with laryngeal preservation

The superiorly based platysma myocutaneous flap has been previously described and used extensively for repair of oral defects. This flap had limited usefulness for hypopharyngeal reconstruction for two reasons: tumor resection that necessitates ligation of the facial vein and artery renders this flap highly unreliable; and the superiorly based flap would require a very long pedicle for hypopharyngeal reconstruction. The inferiorly based flap provides a reliable thin flap that is ideal for hypopharyngeal reconstruction. It has been used in 10 patients after tumor resection or after extensive lye burns. Its use, however, is limited if an ipsilateral radical neck dissection is required. The superiorly based platysma myocutaneous flap has been previously described and used extensively for repair of oral defects. This flap had limited usefulness for hypopharyngeal reconstruction for two reasons: tumor resection that necessitates ligation of the facial vein and artery renders this flap highly unreliable; and the superiorly based flap would require a very long pedicle for hypopharyngeal reconstruction. The inferiorly based flap provides a reliable thin flap that is ideal for hypopharyngeal reconstruction. It has been used in 10 patients after tumor resection or after extensive lye burns. Its use, however, is limited if an ipsilateral radical neck dissection is required.

Massive parotid cancer

A 26-year-old and 4.2 kg massive mixed parotid tumour which had turned malignant in the previous five months was treated. A radical parotidectomy and ipsilateral radical neck dissection were performed, and the subsequent cheek defect was covered by a pectoralis major myocutaneous flap. Facial reanimation, however, could not be done at the same sitting because of anesthetic problems.