Level IIb Research Articles

Distribution pattern of metastatic lymph nodes in 870 cases of nasopharyngeal carcinoma: A clue for individualized elective prophylactic neck irradiation.

e18049 Background: We aimed to explore a potential individualized elective prophylactic neck irradiation (iEPNI) to optimize the current strategy by investigating the distribution of metastatic lymph nodes (LNs) in nasopharyngeal carcinoma (NPC). Methods: Magnetic resonance imaging (MRI) and clinical data of 870 non-distant metastatic NPC patients admitted to the Hunan Cancer Hospital between January 2019 and December 2019 were reviewed. All patients were staged using the 8th TNM staging system, and the LNs location was assigned based on the 2013 guidelines. According to the distribution patterns of the LNs in NPC, the intra-regional lymphatic drainage levels were categorized into the following three stations: Station 1st of level VIIa and II; Station 2nd of level III and Va; and Station 3rd of level IV, Vb, and Vc. Other levels were defined as extra-regional areas. Results: The incidence of LNs metastasis was 822/870 (94.5%), including 198 cases of unilateral metastasis and 624 cases of bilateral metastasis. Among the 870 patients, the most frequently involved intra-regional lymphatic drainage was level IIb (87.1%), followed by level VIIa (80.0%), IIa (61.8%), Va (30.6%), IV (21.4%), Vb (8.9%), and Vc (1.1%). In the extra-regional areas, the detailed LNs distribution was: level Ia (0.2%), level Ib (7.7%), level VI (0.1%), level VIIb (5.6%), level VIII (5.5%), level IX (0.3%), and level X (0.2%). The rates of LNs metastasis in Station 1st, Station 2nd, and Station 3rd were 820/870 (94.3%), 532/870 (61.1%), and 199/870 (22.9%), respectively. Only 4 patients were considered to be skipping metastasis among the three stations (4/870, 0.5%). Additionally, in 203 patients with unilateral Station 1st LNs metastasis, there were 86 (42.4%) and 37 (18.2%) patients with ipsilateral Station 2nd and Station 3rd metastasis, respectively, and 3 (1.5%) and 1 (0.5%) patients with contralateral Station 2nd and Station 3rd LNs metastasis, respectively. Conclusions: LNs spread from Station 1st to Station 3rd successively with rare skipping metastasis. A potential iEPNI strategy of prophylactical neck irradiation to the ipsilateral latter node-negative station might be feasible, which is detailed as follows: irradiation to Station 1st in patients with no LNs metastasis, irradiation to Station 2nd in patients with only Station 1st metastasis, and irradiation to Station 3rd in patients with Station 2nd metastasis but without Station 3rd metastasis. Further prospective investigations are expected to validate the strategy.

Occult lymph node metastasis in cN0 tongue squamous cell carcinoma: A prospective observational study.

e18066 Background: Tongue squamous cell carcinoma (TSCC) is prone to occult lymph node metastasis, and preoperative evaluation of cervical nodes is critical for determining treatment strategies. There is scarce report of detecting occult lymph node metastasis in TSCC by using multi-parameter magnetic resonance imaging (mpMRI), spectral computed tomography (spectral CT) or other diagnostic functional imaging. In this study, we aimed to analyze the incidence and risk factors of occult lymph node metastasis in cN0 TSCC by comparing preoperative imaging with postoperative pathology results. Methods: This study prospectively enrolled newly-diagnosed cN0 TSCC patients admitted to the Hunan Cancer Hospital between May, 2022 and December, 2022. All patients underwent primary resection and selective dissection of cervical lymph nodes. MpMRI and spectral CT scan of oral cavity and neck were performed prior to surgery. Preoperative evaluation of lymph node metastasis was conducted by two senior radiologist independently. The location of cervical lymph nodes was assigned based on the 2013 consensus guidelines. Results: A total of 26 cN0 TSCC patients (6 cT1 stage, 13 cT2 stage, and 7 cT3 stage) were enrolled. The median age was 53 (range, 36-64), and there were 25 males. Among all patients, 13 patients underwent unilateral cervical lymph node dissection, while 13 patients underwent bilateral cervical lymph node dissection. A total of 208 lymphatic drainage areas were resected, and 1003 lymph nodes were removed. There were 7 of pT1, 12 of pT2, 7 of pT3 based on postoperative pathological stages. Besides, there are 21 cases staged pN0, 2 cases staged pN1, 2 cases staged pN2, and 1 case staged pN3. Among the 26 patients, 5 (19.23%) cases had occult lymph node metastasis. A total of 8 metastatic lymph nodes (4 in ipsilateral Ib level, 1 in contralateral Ib level, 3 in IIa level ipsilateral side) were detected in the whole group. No lymph node metastasis was detected in level IIb, III and IV. The median maximum diameter of metastatic lymph nodes was 12 mm (range 5 to 15 mm), and 1 extra-nodal extension was observed. Moreover, all occult lymph node metastases occurred in patients with a primary invasion depth of ≥ 5 mm (29.41%, 5/17). Conclusions: The incidence of occult lymph node metastasis in cN0 TSCC remains high under functional imaging diagnostic technology. Preventive neck dissection is necessary for patients with cN0 disease, especially those with primary tumor invasion depth exceeding 5 mm.

Mother-child separation after twin birth in a maternity unit with an appropriate level of neonatal care.

To evaluate the mother-child separation rate in twin pregnancies delivered in maternity units offering an appropriate level of neonatal care. JUMODA is a French, prospective, population-based cohort study of twin deliveries, including 7998 women who gave birth in maternity units with appropriate levels of neonatal care based on thresholds for weeks of gestational age (wGA) and birth weight according to French guidelines: level I (≥36 wGA), IIA (≥34 wGA), IIB (≥32 wGA and ≥ 1500 g), and IIII (<32 wGA or < 1500 g). The primary outcome was mother-child separation, defined as the transfer of at least one twin or the mother to another hospital. Mother-child separation occurred in 2.1% of pregnancies. This rate was significantly higher in level I (4.8%, 95% confidence interval [CI] 1.5-12.5) and IIA (3.4%, 95% CI 2.4-4.7) compared with level IIB (1.6%, 95% CI 1.1-2.3) and level III maternity units (2.1%, 95% CI 1.9-2.8). In level IIA units, the rate of mother-child separation was higher for babies born between 34 and 36 wGA (8.3%) than for those born at 36 wGA or beyond (1.7%). In level IIb, the rate of mother-child separation for babies born between 32 and 34 wGA (7.5%) was higher than for those born between 34 and 36 wGA (2.1%) and at 36 wGA or beyond (0.9%). Mother-child separation rates were low but differed by level of care. By using specific thresholds for twins to define levels of care, rather than data from singleton births, one-fifth of mother-child separations could have been avoided.

P3 Flap: Technique for Fingertip Reconstruction

Summary: Fingertip amputations represent an important spectrum of injuries, and most are avulsions or crush trauma. There is no consensus about one single standard treatment, and a wide number of techniques are available. The authors present the P3 flap as an option for covering fingertip defects with bone exposure, avoiding painful scars in the pulp area, without a donor site. This study included 12 fingertips with amputated segment not available for replantation. Volar oblique fingertip defects and transverse amputations with bone exposure, not more proximal than Hirase Zone IIB, were included. Defects were less than 2 cm. The patients were followed up for an average of 6 months. The aesthetic and functional outcomes and fingertip discrimination recovery were evaluated at 6 months by the static two-point discrimination (2-PD) test and DASH score (quick version). The average postoperative 2-PD test at 6 months was 5.9 mm (range from 5 to 8 mm). The mean healing time of the fingertip was 4 weeks. Nail deformity was reported in three cases with level IIB of amputation. None of the P3 flaps failed, and local infection was not reported. The average DASH score at 6 months was 1.1. The mean time to return to work was 38 days (range from 30 to 53). The P3 flap proposed in this study demonstrates a reliable single-stage technique, performed under local anesthesia, for fingertip defect reconstruction, avoiding skin incision and scars in the pulp region and preserving digital length and nail bed.

A CLINICOPATHOLOGICAL STUDY OF PATIENTS WITH CERVICAL LYMPHADENOPATHY BY FNAC AND ITS HISTOPATHOLOGICAL CORRELATION

Background- Cervical lymphadenopathy is one of the most frequent clinical presentation of patients attending out patient department and also the most common manifestations of underlying pathology of the head and neck region, with numerous differential diagnoses such as neoplasms and infections Fine needle aspiration cytology (FNAC) is considered as a safe, easy, quick and also the rst line diagnostic technique for evaluation of cervical lymphadenopathy. The study comprised of 150 Materials and methodpatients clinically presenting with cervical lymph node swelling coming for FNAC to the department of pathology. Out of 150 patients, 25 patients underwent surgery and histopathological correlation was done for these patients. Results: Among the 150 cases majority of the patients were males 70 % with M:F ratio 2.33:1.Age of the patients ranged from 1 to 90 years with a mean age of 40.44 years.Most of the lymph node lesions were seen in the age group of 21-30 years(20.67%). Level IIb lymph node was most commonly affected(36%).In FNAC 63.70 % cases were benign and 36.29 % cases were malignant.Among the benign lesions Reactive lymphoid hyperplasia was most common(25.9%) and in the malignant lesions metastatic carcinoma was most common(19.25%). In HPE 82.5% were benign and 17.5% were malignant.There was a strong correlation among the FNAC and HPE ndings where reactive lymphoid hyperplasia was found to be most common benign lesion. Conclusion: Fine Needle Aspiration Cytology is a rapid, safe, efcient, cost-effective and the rst line investigation for diagnosis of cervical lymph node lesions. Histopathological examination however remains the gold standard for denitive diagnosis of in certain malignant lymph node lesion

Difference after radiotherapy observed in patients with nasopharyngeal carcinoma

To evaluate the shrinkage rate of small cervical lymph nodes (SCLNs) at different levels in patients with nasopharyngeal carcinoma (NPC) treated with radiotherapy retrospectively. 96 adult patients with NPC who underwent intensity-modulated radiotherapy (IMRT) at our institution were analyzed and followed-up. Evaluation of the response (shrinking rate) of SCLNs was determined by the bidimensional tumor area. Binary logistic regression was conducted to explore the risk factors associated with the shrinking rate of SCLNs. Of the 96 patients included in this study, 1,194 SCLNs were identified. Among the SCLNs, 28.6% were level IIb and 21.3% were level IIa. SCLNs at level IIa (96.1%), tended to have a response effect of no change (NC) with shrinking rate <50% (odds ratio [OR]=0.007; 95% CI: 0.003-0.021, P=5.287×10-25). Conversely, the most proportionate share of SCLNs for shrinking rate ≥50% (complete response (CR) or partial response (PR)) was observed at level IIb (67.2%) (OR=6.104; 95% CI: 3.267-11.407, P=1.420×10-8). There was no significant difference of shrinking rate between irradiation doses of 60Gy and 63Gy. Most SCLNs at level IIa were not shrunk after radiotherapy. The irradiation dose of SCLNs at level IIa should be not more than 60Gy to reduce side effects.

An overview of the Swiss Neonatal Network &amp; Follow-up Group (SwissNeoNet)

: The Swiss Neonatal Network & Follow-up Group (SwissNeoNet) started as a paper based standardized data collection for very preterm born infants in 1995 for the purpose of research. It has since evolved into a sophisticated online medical registry with the chief aim of improving the quality of medical care for high-risk newborn infants through research, education and collaborative audit. In support of its aim, it collects primary hospitalization and neurodevelopmental follow-up data of various cohorts of newborns from all level III neonatal intensive care units (NICUs) and all peripheral intermediate care level IIB neonatal units (NUs) in Switzerland. It coordinates clinical, epidemiological and health-services research that provide orientation for Swiss neonatologists on how their performance compares with that of other networks, how different approaches in practices without clear evidence base associate with outcome, or how processes and outcomes evolve longitudinally. Its research also allowed former very preterm born children to express their own perception of their quality of life. SwissNeoNet closely monitors and compares NICUs and NUs and provides the infrastructure for quality improvement collaboratives. All units jointly and openly compare their performance and identify potential for changing clinical practices which has led to several local improvement projects as well as revisions of national treatment recommendations. To collaborate in research, to acquire benchmarks, and to serve as a benchmark, SwissNeoNet is actively engaged in several national and international collaborations. Receiving no governmental support, SwissNeoNet struggles with a limited budget to continuously operate a multifaceted, complex network with an electronically advanced, security sensitive infrastructure. Nevertheless, it plans expanding by connecting closer to the families and ultimately the former very preterm born children in the near future: building a patient reported outcome measure (PROM) repository and thus learning more about the parental/patient perspective will benefit clinical research, qualitative research, quality assessment, long-term follow-up recruitment and may even pave the way to later expand into citizen science and personalized health care.

Rate of occult neck nodal metastasis in primary and salvage laryngectomy.

Rate of occult neck nodal metastasis in primary and salvage laryngectomy.

Presence of nodal metastasis in early oral cavity cancer: A retrospective study

Objectives: The pattern of metastasis in the neck nodes and associated clinical factors in patients with oral cavity cancer were the subjects of this research, and their patterns were evaluated.Materials and Methods: Patients with oral squamous cell carcinoma (OSCC) who did not have a history of other cancers and who were not currently undergoing neo-adjuvant concomitant chemo-radiotherapy or radiotherapy were chosen for research. In total, 300 patients met these criteria.Results: 109 out of 300 instances of oral squamous cell carcinoma patients with clinically and radio-logically N0 neck had microscopic evidence of metastatic lymphadenopathy. There is a possibility of metastases in level IIb, but they are much more common in levels IB, III, and IV. Positive nodes on level IIB were correlated with three positive nodes on level IIA. Conclusion: During the follow-up, there was a substantial correlation between the size of the primary tumor and the number of distant metastases.

Normal size of benign upper neck nodes on MRI: parotid, submandibular, occipital, facial, retroauricular and level IIb nodal groups

Nodal size is an important imaging criterion for differentiating benign from malignant nodes in the head and neck cancer staging. This study evaluated the size of normal nodes in less well-documented nodal groups in the upper head and neck on magnetic resonance imaging (MRI). Analysis was performed on 289 upper head and neck MRIs of patients without head and neck cancer. The short axial diameters (SAD) of the largest node in the parotid, submandibular, occipital, facial, retroauricular and Level IIb of the upper internal jugular nodal groups were documented and compared to the commonly used threshold of ≥ 10mm for diagnosis of a malignant node. Normal nodes in the parotid, occipital, retroauricular and Level IIb groups were small with a mean SAD ranging from 3.8 to 4.4mm, nodes in the submandibular group were larger with a mean SAD of 5.5mm and facial nodes were not identified. A size ≥ 10mm was found in 0.8% of submandibular nodes. Less than 10% of the other nodal group had a SAD of ≥ 6mm and none of them had a SAD ≥ 8mm. To identify malignant neck nodes in these groups there is scope to reduce the size threshold of ≥ 10mm to improve sensitivity without substantial loss of specificity.

PSAT280 Role of Radiofrequency Ablation Therapy in Recurrent Papillary Thyroid Carcinoma - A Case Study

Abstract Introduction Radiofrequency ablation (RFA) has been studied in solitary and reoccurring/ persistent papillary thyroid cancer (PTC) with favorable results. This case describes a patient with reoccurring PTC who underwent radiofrequency ablation. Clinical Case This is a case of a 68 year old male who was underwent an elective thyroid surgery for compressive multinodular goiter and left inferior parathyroid adenoma. Prior to his surgery he had fine needle aspiration cytologies of multiple nodules that were negative for thyroid cancer. A total thyroidectomy with excision of central cervical lymph nodes, excision of a suspicious right perithyroidal mass and a left inferior parathyroidectomy were performed. The pathology diagnosis was multifocal bilateral papillary thyroid cancer – classical type – with infiltration into perithyroidal adipose tissue and lymph node metastasis (pathological stage: mpT1b pN1a). Serum thyroglobulin was 4.9 ng/mL (reference range 1.6–59.9 ng/mL). Postoperatively, he was given adjuvant radioactive iodine (I-131 120mCi) treatment and suppressive levothyroxine at 250 µg daily, with pretreatment TSH at 14.730 µU/mL and TSH after 4 months of treatment 0.140 µU/mL. Single photon emission computed tomography (SPECT) whole body imaging done seven days post radioactive iodine therapy showed no evidence of distant metastases. Four months after I-131 therapy, a diagnostic ultrasound for a palpable node revealed this to be a right level IIb cystic cervical lymph node (18×16×18 mm) with no overt vascularity. Serum thyroglobulin was &amp;lt;0.2 ng/mL and thyroglobulin antibodies were &amp;lt;14.4 IU/mL. FNA biopsy, with cytology showing papillary thyroid cancer. Needle washout thyroglobulin was elevated (1015.3 ng/mL, reference range &amp;lt; 10ng/mL). This metastatic lymph node was concluded to be recurrent papillary cancer. Surgical dissection and percutaneous alternatives were discussed with the patient. Shared decision making between surgery, intervention radiology and the patient concluded that a less invasive procedure was preferred and the solitary node was a candidate for percutaneous ablation. Post ablation surveillance ultrasonography showed an 80% volume reduction (11×8×12 mm) in node size six weeks post intervention and a 95% volume reduction at six months (8×5×7 mm), with decreased cystic appearance and no vascularity. No complications were reported after the procedure. Conclusion Current guidelines recommend that the mainstay of recurrent thyroid cancer is surgery, followed by radioactive iodine therapy and suppressive thyroid hormone replacement treatment, external beam radiotherapy and/ or chemotherapy. However within recent years, image guided ablation techniques such as radiofrequency ablation has been explored and has become an alternative in selective who wish to avoid extensive lymph node dissection. Multiple studies unanimously report a node volume reduction rate (VRR) of greater than 50%, with some studies reporting almost 99% VRR within 12-24 months; suggesting a role for RFA to replace 'berry picking surgery' in selected patients. Presentation: No date and time listed

Correction to: Influence of Site, Size, Depth of Invasion and Histologic Grading on the Occurrence of Cervical Level IIb Metastasis and Extranodal Extension in Clinically N0 Neck of Patients with OSCC: A Single Center Retrospective Analysis

Correction to: Influence of Site, Size, Depth of Invasion and Histologic Grading on the Occurrence of Cervical Level IIb Metastasis and Extranodal Extension in Clinically N0 Neck of Patients with OSCC: A Single Center Retrospective Analysis

Lymph node metastasis in level IIb in oropharyngeal squamous cell carcinoma: a multicentric, longitudinal, retrospective analysis.

Nowadays, 70% of patients in Europe and the USA are affected by a p16 + , potentially HPV driven oropharyngeal squamous cell carcinoma. However, despite the improved survival rate in this group, the quality-of-life remains low in cases which neck dissection took place. In this vein, in recent years, some surgeons have considered to avoid dissection of level IIB, proposing a supra-selective non-IIb neck dissection. A retrospective, longitudinal, multicentric study was conducted, including patients with pathologically confirmed primary HPV + or HPV - OPSCC who went through surgical treatment for the primary lesion and neck dissection. 141 patients were included. Among them, 99 (70.2%) were male and 42 (29.8%) were female. The mean age was 62 ± 9years (range 36-81). The most frequent anatomical location was the tonsil in 63 (44.7%) of patients. The most common approach was the classic transoral oropharyngectomy in 51 (36.2%) patients. Immunohistochemistry for p16 was positive in 62 (44%) patients. One-hundred and five (74.5%) patients received a unilateral ND, and a 36 (25.5%) a bilateral ND. Of those, a 12.8% (18/141) of patients were level IIb LN + . According to our results, level IIb ND should be considered in patients underwent therapeutic ND with positive LN metastasis in level IIa (OR = 9.83; 95% CI 3.463-27.917) or III (OR = 6.25; 95% CI 2.158-18.143), advanced (T3/T4) oropharyngeal primary tumors (OR = 3.38; 95% CI 1.366-8.405), and patients with ENE (OR = 6.56; 95% CI 2.182-19.770), regardless of p16 status. According to our results, level IIb ND should be considered in patients who underwent therapeutic ND with positive LN metastasis in level IIa or III, advanced oropharyngeal primary tumors, and patients with ENE, independently of p16 status. Prospective data are necessary to definitively ensure the safety of omitting ipsilateral or contralateral level IIb ND in cN - patients with early stage disease.

Influence of Site, Size, Depth of Invasion and Histologic Grading on the Occurrence of Cervical Level IIb Metastasis and Extranodal Extension in Clinically N0 Neck of Patients with OSCC: A Single Center Retrospective Analysis.

Depth of Invasion ≥ 4mm, T stage and primary site with more than 20% chances for occult metastasis are currently the accepted indications for elective neck dissection. Nodal metastasis decreases survival by 50%. ENE further reduces the prognosis. Dissection of level IIb lymph nodes in clinically N0 neck does not improve survival. A total of 320 patients were evaluated. Binary and multiple logistic regression and chi-square test were used for data analysis. ROC curve with Youden's J index was used to set up a cutoff value for DOI. The predictor variables were site, size, grading and depth of invasion of primary tumor. Incidence of level IIb metastasis and ENE were the outcomes. The study revealed a significant association and risk stratification between primary tumor characteristics with the occurrence of ENE. The cutoff value for DOI predicting ENE was 12.5mm. Tumors of the oral tongue were an independent risk factor for level IIb metastasis. Size of primary tumor, DOI, tumors of the mandibular alveolus and poor grading are independent risk factors for ENE. Isolated metastasis to level IIb rarely occurs in the absence of concomitant level IIa metastasis. Size, DOI and grading were significantly associated with level IIb metastasis. However, only tumors of the oral tongue were independent risk factor.

The Interest of Non-Invasive Ventilation in The Management of Respiratory Pathology of Premature Newborns at Ehs Nouar Fadela

The rate of prematurity has increased markedly over the last 20 years. These preterm infants have a high risk of morbidity, especial respiratory, compared to full-term infants. Nasal continuous positive airway pressure (NCPAP) has significantly improved the prognosis of this respiratory distress (MMH). The objective: The objective of this work was to study risk factors and management of respiratory pathology in premature newborns at the EHS NOUAR FADELA. Patients and methods: This is a retrospective, descriptive, mono-centric study including all newborns having recourse to CPAP and managed in a level IIb maternity hospital at the E Nouar Fadela between January 2019 and June 2021. Pearson's Chi-squares were used for statistical testing. A p-value&lt;0.05 represented a statistically significant difference. Results: We recorded 12633 deliveries of which 623 were preterm births representing 4.93% of births. For maternal characteristics: the average age was 29 ±5.57 years. Maternal morbidity was present in 20.9% gravidic hypertension and 11.7% gestational diabetes. Neonatal morbidity was dominated in preterm newborns was respiratory distress in 41.4%. Mechanical ventilation was necessary in 12.6% of cases. The two main causes of respiratory distress were MMH, maternal-fetal infection, respiratory distress, and respiratory failure. Significant risk factors for respiratory distress were gestational age, male sex and pre-labour caesarean birth (p&lt;0.05). Conclusion: The use of NIV in newborns with respiratory distress is not negligible. Our results confirm the effectiveness of NIV. It is also essential to limit the use of pre-labour caesarean section to these terms whenever possible.

Primary and recurrent regional metastases for lateralized oral cavity squamous cell carcinoma

ObjectivesMap regional lymph node metastases for lateralized oral cavity squamous cell carcinoma (OCSCC) and evaluate factors associated with regional metastases and recurrence. Materials and methodsRetrospective cohort study of 715 patients with lateralized OCSCC surgically treated in 1997–2011. Analysis was performed using log-rank, Kaplan-Meier, and multivariable logistic and Cox regression. ResultsRegional metastases were identified in ipsilateral levels IIA (24%), IB (18%), III (13%), V (9%), IV (7%), IA (2%) and IIB (1%) and the contralateral neck (3%). Lymphovascular invasion (LVI) (Hazard Ratio [HR] 2.2, 95% Confidence Interval [CI] 1.2–3.9) and T category (T3 vs. T1: HR 4.1, 95% CI 1.9–9.3; T4 vs. T1: HR 2.3, 95% CI 1.2–4.3) were associated with regional metastases. Most (71%) isolated regional metastatic recurrences were in undissected levels of the neck, including 58% in levels IV and V. Tumors of the hard palate (HR 4.3, 95% CI 1.2–16.1), upper alveolus (HR 3.2, 95% CI 1.0–4.7) or with LVI (HR 2.0, 95% CI 1.0–3.9) were associated with isolated regional recurrence. For upper alveolar/hard palate tumors, depth of invasion (DOI) ≥4 mm (P = .003) and LVI (P = .04) were associated with regional metastases. ConclusionsFor lateralized OCSCC, elective neck dissection of level IIB or the contralateral neck may rarely be needed, but additional surgical or radiation treatment of levels IV and V may be considered based on patient risk factors, including T category 3–4 or LVI. For upper alveolar/hard palate tumors, DOI ≥4 mm is an appropriate threshold for elective neck dissection.

Clinical comparison of superior thyroid artery perforator flap and sternocleidomastoid myocutaneous flap for intraoral reconstruction

The aim was to evaluate the techniques and outcomes of superior thyroid artery perforator flaps (STAPF) for intraoral reconstruction and to compare them with those of the sternocleidomastoid myocutaneous flap (SCMMF). The cases of 43 patients who underwent reconstruction with either a SCMMF or STAPF for the repair of a medium-sized intraoral defect, between January 2013 and December 2020, were reviewed retrospectively. Although both flaps are based on the superior thyroid artery, their specific harvesting techniques largely differ. All SCMMF (n = 23) were superiorly-based rotational flaps with myocutaneous designs. The STAPF cases (n = 20) included 18 septocutaneous flaps and two chimeric flaps. The flap size was larger in the STAPF group (P = 0.008), while incomplete level IIB dissection (oncological safety) was more frequent in the SCMMF group (P = 0.002). The flap necrosis rate was lower in the STAPF group (STAPF 15% vs SCMMF 34.8%, though this was not statistically significant). Cox multivariate analysis showed that the postoperative flap outcome (total flap necrosis vs flap survival; hazard ratio 27, 95% confidence interval 2.149–336.05; P = 0.001) and complications (excluding fistula) (hazard ratio 14, 95% confidence interval 1.314–142.767; P = 0.029) were associated with overall patient survival. Both speech (P < 0.001) and neck mobility (P < 0.001) functions were superior with STAPF reconstruction. Compared with the traditional SCMMF, the STAPF was found to have a lower necrosis rate with uncompromised oncological safety during harvesting. The STAPF is a good alternative for the repair of medium-sized head and neck defects.

Prevalence and Patterns of Nodal Metastasis Among Oral Cavity Cancer Patients: A Prospective Observational Study.

Lip and oral cavity cancer remains the most common cancer among Indian males and third most common cause of cancer-related deaths in India. Cervical lymph node metastasis is one of the most important prognostic factors in oral cavity cancer. The aim of present study was to estimate the prevalence of nodal involvement and analyse patterns of nodal metastasis in oral cavity cancer patients. This prospective observational study was conducted between January 2019 and June 2020. Patients of oral cavity squamous cell carcinoma undergoing surgery with simultaneous neck dissection were included. Data pertaining to the clinical profile, treatment and histology details were collected and analysed. A total of 63 patients were included in present study. Out of 63 patients, unilateral neck dissection was performed in 47 (75%), while 16 (25%) underwent bilateral neck dissection. Overall clinical and pathological nodal positivity rates were 75% and 52%, respectively. Level I (48%) followed by IIa (20%) were most commonly involved stations. Combined involvement of level IV and V was seen in only 5%, and no skip metastasis was reported in level IV and V. Level I and II are the most commonly involved stations in oral cavity squamous cell carcinoma (SCC). Oral SCC has a predictable nodal spread pattern with no skip metastasis to level IV/V noted in present study. There is a need for good quality randomised control trials to optimise the treatment protocols in clinically node-positive patients with respect to level IIB and V dissection.

Prevalence of Positive Level IIb Lymph Nodes in Tongue Carcinoma: Experience From a Tertiary Care Center in North India.

IntroductionComplications during and after dissection of level IIb lymph nodes include spinal accessory nerve (SAN) dysfunction, which results in the limitation of shoulder movements and, thus, hurts the quality of life. The current study aims to know the occurrence of level IIb lymph node positivity in tongue carcinoma.MethodsThis cross-sectional study was conducted from January 2019 to December 2019 in a tertiary care center in North India. Adult cases with primary ulcer-proliferative growth over the lateral border of the tongue were included in the study. The level IIb lymph node positivity from the postoperative histopathology report was the primary outcome measure of this study. To investigate the potential association of tumor size on level IIb lymph node positivity, we compared the maximum tumor dimensions among the level IIb lymph node-positive and -negative groups. In addition, to analyze the impact of the tumor's invasive nature on level IIb lymph node positivity, we compared the depth of invasion and proportion of cases with muscle involvement among the level IIb lymph node-positive and -negative groups. Lastly, to investigate their concurrent occurrences, we compared the number of level IIb lymph node-positive cases among the level IIa lymph node-positive and -negative groups.ResultsA total of 39 patients fulfilling the inclusion criteria were included in the study. Only six had positive level-IIb lymph nodes. No significant associations of tumor size, invasion depth, muscle invasion, or involvement of level IIa lymph nodes with the positivity of level IIb lymph nodes were found. However, only three were level IIb lymph node-positive in 28 level IIa lymph node-negative cases.ConclusionConsidering the low risk of isolated level IIb lymph node positivity in level IIa lymph node-negative cases, the dissection of level IIb nodes could be omitted during the surgical excision of the tumor. However, radiological investigations detecting metabolic activity should be used in the preoperative period and postoperative follow-up to detect early lymph node involvement and disease recurrence.

Characteristics of locoregional extension of unilateral nasopharyngeal carcinoma and suggestions for clinical target volume delineation

BackgroundTo summarize the characteristics of local invasion and distribution of metastatic lymph nodes in unilateral nasopharyngeal carcinoma (NPC) by magnetic resonance imaging (MRI) to provide references for the optimization of clinical target volume.MethodsMRI and clinical data of 176 cases of unilateral NPC admitted to the Hunan Cancer Hospital from January 2019 to December 2019 were collected. Unilateral NPC was defined as a lesion confined to the one side of the nasopharynx and had not exceeded the midline as judged by MRI.ResultsIpsilateral levator veli muscle (63.1%, 111/176), tensor veli palatini muscle (55.7%, 98/176), parapharyngeal space (50.0%, 88/176), and prevertebral muscle (43.7%, 77/176) were more likely to be invaded. Contralateral parapharyngeal space and skull base foramina were not invaded. All local invasions presented as continuous invasion from gross lesions and discontinuous invasions were not observed. The overall lymph node metastatic rate was 89.8% (158/176), of which bilateral metastasis accounted for 56.3% (89/158), and ipsilateral metastasis accounted for 88.1% (155/176), which was higher than the contralateral metastatic rate (55.4%, 94/176) (P < 0.001). The most common regions of lymph node metastasis were level IIb (82.4%), VIIa (69.9%), IIa (54.0%), and III (54.0%). Only one patient had skipping lymph node metastasis (0.6%).ConclusionLocal invasion of unilateral NPC was characterized by continuous invasion from proximal to distal sites, and lymph node metastasis occurred from the upper to lower neck. Contralateral parapharyngeal space and skull base foramina had a very low probability of invasion, and routine prophylactic radiation may not be necessary.