Selective Neck Dissection Research Articles

Learning curve for the combined trans-oral and chest approach to endoscopic selective neck dissection: a cumulative sum (CUSUM) analysis.

The combined trans-oral and chest approach is a novel technique for endoscopic selective neck dissection (SND), with satisfactory oncological safety and cosmetic results. However, this hybrid approach is difficult, and the learning curve remains unclear. In this study, we aimed to evaluate the short-term outcomes for this hybrid approach, and to define the associated learning curve. Clinical data and surgical outcomes of 58 PTC patients who underwent endoscopic SND via combined trans-oral and chest approach between September 2020 and April 2023 were retrospectively reviewed. The cumulative sum (CUSUM) sequential analysis technique is used to detect change, and has been applied for the evaluation of learning curves. The study population included 58 patients (40 females, 18 males), with mean age of 38.9 ± 12.7years and average body mass index of 22.6 ± 4.8kg/m2. In all cases, the same surgical team performed endoscopic SND via combined trans-oral and chest approach. The numbers of positive/retrieved lymph nodes were 4.3 ± 3.2/27.8 ± 8.4 in the lateral compartment and 4.0 ± 3.5/8.4 ± 5.1 in the central compartment. The learning curve was evaluated in terms of an initial phase (20 cases) and a mature phase (38 cases). Operative time was longer during the initial phase, compared to the mature phase (375.2 vs. 274.6min, p = 0.002). The frequency of operative complications was higher during the initial phase, compared to the mature phase (85% vs. 55.3%, p = 0.048). After the experience acquired using endoscopic SND via combined trans-oral and chest approach to treat PTC in 20 patients, the number of complications decreased significantly. Compared to data collected for the initial phase, data collected for the mature phase showed trends toward decreased operating time.

DICER-1 Mutation Associated Sarcoma of Thyroid in An Adult Male

Abstract Introduction/Objective DICER-1 is an autosomal dominant tumor predisposition syndrome caused by germline DICER1 mutations. In the thyroid, it is associated with an early-onset multinodular goiter (MNG) and low-grade thyroid carcinomas. The aggressive variants thyroblastoma and poorly differentiated carcinoma are however seen in the pediatric age group. We report a case of DICER-1-associated (rhabdomyo) sarcoma without primitive components in an adult male. Methods/Case Report A 44-year-old healthy male with a family history of MNG, presented with a large left neck mass confirmed on imaging with largest 6.4cm, and extension into the mediastinum. FNA showed a malignant spindle cell- rich neoplasm with negative expression for Keratins, TTF-1, PAX-8, Calcitonin, INSM- 1 and SOX-10. The CEA and calcitonin were normal. The lymphoma was excluded by flow cytometry. The patient underwent a left thyroidectomy with central and left selective neck dissection. On gross examination, the left lobe of the thyroid was replaced by a tan- white, partially encapsulated solid mass. Microscopic examination revealed nests and sheets of ovoid to spindle- shaped cells with eosinophilic cytoplasm in fascicles with hypocellular areas with loose stroma. Foci of rhabdomyoblastic differentiation with straps cells, positive for desmin and myogenin were identified. Brisk mitotic activity and tumor necrosis were present. No primitive thyroid epithelium or blastemal component was identified. Tumor cells were negative for S100, SOX10 CD34, CD31, SMA, calponin, CD99, NKX2.2, SS18-SSX which excluded malignant peripheral nerve sheath tumor, angiosarcoma, leiomyosarcoma, Ewing’s sarcoma, and synovial sarcoma. Next-generation sequencing showed a DICER1 c.4517G>A (p.W1506) and c.5437G>C (p.E1813Q) mutation, both variants reported as germ-line variants. A final diagnosis of DICER-1-associated rhabdomyosarcoma was rendered. The patient underwent rehabilitation at another facility and lost to follow-up. Results (if a Case Study enter NA) NA Conclusion The case highlights the expanding spectrum of DICER-1-associated malignant tumors and the importance of keeping it in the differential diagnosis of unusual malignant tumors of the thyroid even in adults.

MiNEN of base of tongue - first case report in literature.

Mixed neuroendocrine and non-neuroendocrine neoplasms (MiNENs) refer to a heterogenous group of rare neoplasms which is usually composed of a neuroendocrine population which is either well differentiated and more frequently poorly differentiated along with a non-neuroendocrine component, each of the above accounting for at least 30% of the tumour population. It is most commonly seen in the gastro-entero-pancreatic tract. MiNENs have an aggressive behaviour due to its high grade neuroendocrine component and have poor prognosis. This is the first case reported in literature of a MiNEN in the oropharynx. 69 year old male patient with no co morbidities presented to the outpatient department with complains of odynophagia for 1 month. He had history of neoadjuvant chemotherapy followed by transoral robotic surgery (TORS) with right selective neck dissection (SND) done in 2019 for carcinoma base of tongue. On flexible laryngoscopy, an ulcerative lesion was noted over the left base of tongue. Although PET scan done showed no significant abnormalities. Biopsy from the lesion showed features of poorly differentiated carcinoma along with morphological features of poorly differentiated neuroendocrine carcinoma (small cell carcinoma). He was planned for upfront surgery (TORS with left SND). Post operatively recovery was uneventful and patient was on ryles tube feed for 12 days. Final histopathology report showed features of mixed neuroendocrine non neuroendocrine neoplasm. He has been on follow up for 1 year with no features of recurrence. MiNEN is an aggressive tumour which has poor prognosis and is most commonly located in the gastrointestinal tract. This is the first case reported in oropharynx who has been successfully treated and has been on follow up.

Risk factors and distribution pattern of lateral lymph node recurrence after central neck dissection for cN1a papillary thyroid carcinoma

BackgroundThe indication and extent of selective lateral neck dissection (LND) for cN1a papillary thyroid carcinoma (PTC) remain uncertain. The present study aimed to identify potential predictors and distribution pattern of lateral lymph node recurrence (LLNR) after central neck dissection in cN1a PTC patients.MethodsThe cN1a PTC patients who underwent initial central neck dissection at our centre were retrospectively reviewed, and the median follow-up period was 6.8 years. Reoperation with LND was performed when LLNR was confirmed. Risk factors for LLNR were identified, and the metastatic status of each lateral level was recorded.ResultsOf the 310 patients enrolled in the present study, fifty-eight patients (18.7%) presented with LLNR. Six independent factors, including tumour diameter, pathological T4 stage, number of involved central lymph nodes, pTNM stage, extrathyroidal extension, and I131 treatment (P values < 0.05) were identified via multivariate analysis. LLNR was found at level II in 26 patients (44.8%), level III in 38 patients (65.5%), level IV in 30 patients (51.7%), and level V in 8 patients (13.8%). The number of positive lateral lymph nodes at levels II, III, IV and V was 44 (22.9%), 76 (39.6%), 63 (32.8%), and 9 (4.9%), respectively.ConclusionsFor cN1a PTC patients who underwent central neck dissection, tumour diameter ≥ 2 cm, pathological T4 stage, number of involved central lymph nodes ≥ 3, pTNM stage III-IV, extrathyroidal extension, and failure to receive I131 treatment were independent predictors of LLNR, which was more likely to occur at levels III and IV.

Selective neck dissection-the supraomohyoid, lateral, and anterolateral dissection techniques

In this article, the indications for performing the supraomohyoid, lateral, and anterolateral selective neck dissections will be discussed. Super selective neck dissections, though not included with a specific technique section, will also be briefly examined. An emphasis of the authors’ techniques will be illustrated with pertinent anatomy as well as post-operative care and complications to consider. Photographs will accompany the write-up in order to provide the reader with an anatomic operative reference.

Outcome of Upfront Surgically Resected Patients of Oral Tongue Squamous Cell Carcinoma and Factors Affecting it: Experience from Tertiary Care Facility in North India.

Oral tongue squamous cell carcinoma (OTSCC) is the most aggressive subsite among oral cancers. The poor survival rate has been primarily attributed to high loco-regional recurrence. Two recent developments viz. incorporation depth of invasion (DOI) in American Joint Committee on Cancer (AJCC) TNM 8th edition and elective neck dissection in clinically negative neck have potential to improve survival. We in our study have tried to look at overall survival and factors affecting patients of only OTSCC. 144 patients of OTSCC operated upfront between July 2017 and December 2023 were included in our study. Selective neck dissection was done in all patients with clinically negative neck. T staging was done using both AJCC TNM 7th and 8th edition. Primary objective of the study was to determine the overall survival and factors affecting it. The secondary objectives were to determine the disease-free survival and to look at the effect of forementioned new developments in patients in OTSCC. Mean overall survival and disease-free survival in our study cohort was 48.8 months and 48.3 months respectively in follow up period ranging from 2 months to 75 months. DOI > 10 millimetres and involved margins were factors significantly associated with survival on multivariate analysis. Lymph node metastasis was detected in 32(35.2%) patients out of 91 patients with clinically negative neck and 31(21.6%) of patients were upstaged from T1/T2 in AJCC TNM 7th to T3/T4 according to AJCC TNM 8th edition. The 5-years overall survival of our patients was about 54% with nearly half of our patients presenting in stage III and stage IV. There is need to create awareness in general population as the impact of the new changes will only be seen if patients present at an early stage.

Synchronous occurrence of oral squamous cell carcinoma and Warthin's tumor: systematic review and case report.

We systematically reviewed the literature on the co-occurrence of squamous cell carcinoma (SCC) and Warthin's tumor (WT), thought to be quite rare, to help reduce misdiagnosis and improve treatment planning. For this systematic review, we searched for articles in the Web of Science and PubMed databases, analyzed relevant studies for forward and backward citations, and identified only articles reporting on the "co-occurrence" of WT and SCC. Of the 237 studies identified, 12 comprising 18 patients met the inclusion criteria, to which we added one study from our institution. Most WTs were associated with SCC in the parotid gland or cervical lymph nodes. Most patients (89.5%) underwent selective or radical neck dissection due to identification of lesions separate from the primary SCC. Despite its frequent co-occurrence with other neoplasms, WT in the parotid or cervical lymph nodes tends to be misdiagnosed as a metastatic node when SCC is observed as the primary tumor. Factors to consider in diagnosis and neck management include identification of an association other than growth or development by lymphangiogenesis and whether the patient is a smoker, a strong risk factor.

Nodal Metastases in Stage 3 Head and Neck Melanoma: Patterns of Metastases and Patterns of Failure.

Stage 3 patients with clinically positive nodal metastasis are treated with therapeutic neck dissection and adjuvant systemic therapy. The aim of our study was to examined the predictability of pre-operative CT as a nodal drainage assessment tool. Retrospective review of all patients with clinically positive head and neck cutaneous melanoma between 2010 and 2019. Clinical disease was diagnosed as radiological suspicious, biopsy-proven node. A pre-operative CT evaluation for nodal metastasis was compared to pathology report. A total of 53 patients were included. Forty patients (75.5%) were males with a mean age of 59 (SD 15.52). The majority of patients (26.4%) had an unknown primary site. The most common sites for primary were the cheek in eight patients (15.1%) followed by forehead (9.4%) and lateral neck (9.4%). Preoperative CT predicted nodal disease in 84.6% of cases. The primary region that mainly failed from the previously described clinical prediction was the upper anterior neck with 83.3% parotid involvement. A total of 10 patients (18.9%) were diagnosis with non-clinical nodes on pathology with a median non-clinical node of 1 (range 1-2). Of them, 9 (90%) were in the same clinical levels detected by CT. Pre-operative CT was associated with a neck level accuracy of 98.1%. Stage 3 head and neck melanoma with clinically positive nodal metastasis that are eligible for an adjuvant systemic treatment, may benefit from a highly selective neck dissection according to their pre-operative imaging studies. This should be further evaluated in a large-scale clinical trial. 3 Laryngoscope, 134:4292-4297, 2024.

Nodal Yield in Level II-IV Neck Dissections in Head and Neck Squamous Cell Carcinoma.

The main objective of this study is to analyze factors associated with nodal yield in level II-IV selective neck dissections (NDs) and the secondary objective is to assess its impact on overall and disease-free survival. Observational retrospective study including adult patients submitted to level II-IV ND from January 2015 to December 2021 in the otorhinolaryngology department of a tertiary hospital center. A total of 44 patients and 78 level II-IV NDs (34 bilateral and 10 unilateral) were included. The median age at diagnosis was 60(22-74) years, and 93.2% of the patients were male. A lower nodal yield was significantly associated with previous radiotherapy (p = 0.042) and extranodal invasion (p < 0.001) and was non-significantly associated with older age (p = 0.065). Furthermore, on a Cox analysis adjusted to the cN status and age, the nodal yield was not associated with five-year disease-free survival (HR = 0.986; 95% CI = 0.922-1.054; p = 0.681) nor with five-year overall survival (HR = 1.006; 95% CI = 0.925-1.095; p = 0.888). A reduced nodal yield in level II-IV NDs was significantly associated with previous radiotherapy and extranodal extension and non-significantly associated with age. There was no association between the nodal yield and five-year overall survival or disease-free survival.

A Case of Parotid Carcinoma Ex Pleomorphic Adenoma with Mixture of Malignant Subtypes

Carcinoma ex pleomorphic adenoma is an uncommon malignant salivary gland tumor that arises from a longstanding pleomorphic adenoma. The carcinomatous component of carcinoma ex pleomorphic adenoma can possess virtually any histologic subtype of salivary gland cancer. We experienced a case of a 61-year-old patient who presented with a right parotid mass that was initially palpated 20 years ago, with a sudden increase in size in the last few months. Radiological and cytological findings from fine needle aspiration biopsy could not exclude malignancy. Total parotidectomy and selective neck dissection were performed for treatment, and carcinoma ex pleomorphic adenoma with mixed carcinoma components of salivary duct carcinoma and myoepithelial carcinoma was diagnosed. After receiving postoperative radiation of 6000 cGy over 6 weeks, there has been no recurrence up to the 18-month follow-up. We report this rare case of carcinoma ex pleomorphic adenoma with mixed malignancy subtypes, accompanied by a review of literature.

P.095 Role of selective neck dissections in the management of carotid body tumours

Background: Carotid body tumours (CBT) are rare neoplasms of the paraganglia at the carotid bifurcation. Histopathologic analysis alone is insufficient to confirm malignancy, requiring metastases to non-neuroendocrine tissue including cervical lymph nodes for definitive diagnosis. The role of selective neck dissection (SND) during CBT surgeries in detecting malignancy and guiding subsequent management remains uncertain. Methods: A retrospective case series was performed on all patients undergoing CBT surgeries with SND between 2002 and 2022. Data collection included demographics, genetic and laboratory testing, imaging, intra- and post-operative complications, follow-up and histopathology. Results: Twenty-one patients underwent CBT resection with SND. Of these, 3 had carotid artery injuries, and 5 had nerve injuries. One patient experienced peri-operative embolic strokes, presumed related to tumour embolization. Three patients were found to have lymph node involvement, confirming malignancy. Malignancy was significantly associated with the risk of carotid injury (p = 0.04.) Conclusions: SND is a useful adjunct in detecting malignancy during CBT resection. The incidence of malignancy in CBT is low but not negligible and SND should be considered in patients with suspected malignancy or high-risk factors. This study’s 14% incidence of malignancy suggests there may be a rationale for considering universal implementation of SND during CBT resection.

The prognostic value of selective neck dissection in early-stage major salivary gland carcinoma: a population-based analysis.

This population-based study aims to assess the survival benefits of selective neck dissection (SND) compared to neck observation in patients with T1/T2N0M0 major salivary gland malignancy (MSGC). We conducted a retrospective review of T1/T2N0M0 MSGC patients who underwent primary tumor surgical extirpation with or without elective neck dissection in the Surveillance, Epidemiology, and End Results database (SEER) from 2004-2015. The impact of SND and clinical variables on overall survival (OS) and disease-specific survival (DSS) was evaluated using Univariate and Multivariate Cox proportional hazards regression models. Kaplan-Meier survival curves were generated, and survival rates were assessed via the log-rank test. Of 3778 post-operative T1-T2N0M0 MSGC patients, 2305 underwent elective neck dissection, while 1473 did not. Median follow-up was 106 months. Univariate and Multivariate analysis identified SND as a prognostic factor for OS in all the study population. After stratified analysis, we found that in the poorly high-grade (differentiated and undifferentiated) patients, the survival showed a significant OS and DSS benefit after receiving SND compared with the neck observations [HR for OS (95%CI): 0.571(0.446-0.731), P<0.001] and [HR for DSS (95%CI): 0.564(0.385-0.826), P=0.003], other than in the well differentiated or moderately differentiated subgroup. Especially, when the pathological is squamous cell carcinoma, the results show that the people underwent SND had better prognosis, not only in OS [HR (95%CI): 0.532(0.322-0.876), P=0.013], but also in DSS [HR (95%CI): 0.330(0.136-0.797), P=0.014]. The multivariate analysis also yielded encouraging results, compared with neck observation, receiving SND bought about a significant independent OS (adjusted HR, 0.555; 95% CI, 0.328-0.941; P=0.029) and DSS (adjusted HR, 0.349; 95% CI, 0.142-0.858; P=0.022) advantage in high grade squamous cell carcinoma MSGC patients. The Kaplan-Meier survival curves also demonstrated that adjusted SND still had significantly better OS(P=0.029) and DSS(P=0.022) than the observation group in patients with high-grade squamous cell carcinoma of MSGC. Poorly differentiated and undifferentiated T1/T2N0M0 major salivary gland malignancy treated with selective neck dissection demonstrated superior survival compared to neck observation, especially in the pathological subtype of squamous cell carcinoma. These findings suggest the potential benefits of multimodal therapy for appropriately selected patients, emphasizing significant clinical implications.

Occult neck metastasis in salvage laryngectomy: a road map for super-selective neck dissection.

This study aimed to solve the debate over the role and extent of neck dissection to treat any occult nodal metastasis in patients undergoing salvage laryngectomy for recurrent and/or residual squamous cell carcinoma of larynx. This was a retrospective study over a time frame of 6 years (2016-2022) of 74 patients who underwent bilateral neck dissection and salvage laryngectomy for recurrent or persistent disease with N0 neck. We calculated the incidence of occult nodal metastasis in ipsilateral and contralateral neck. Incidence of ipsilateral neck disease was calculated as 8.11 per cent and it was 0 per cent in contralateral neck. Regarding ipsilateral nodal level distribution, level II was the highest at 6.76 per cent, followed by level III at 5.41 per cent. There was 0 per cent metastasis in levels IV and IIb. In patients undergoing salvage laryngectomy with N0 neck, ipsilateral super selective neck dissection is considered a convenient and oncologically safe option to treat the neck.

Shoulder Dysfunction and Quality of Life Following Modified Radical and Selective Neck Dissection: A Prospective Comparative Study.

Head and neck cancers are fairly common in India due to the widespread consumption of tobacco and neck dissection is a major component in the surgical management. The objective of this study is to analyze the effect of MRND and SND on shoulder function and quality of life in patients of head and neck cancer. Our study is a prospective comparative study on 65 head and neck cancer patients divided into 2 groups-33 in group A (MRND group) and 32 in group B (SND group). Clinical evaluation of shoulder function was done pre-operatively, 1week, 1month, 3month and 6month post-operatively using arm abduction scores (AAS) and shoulder pain and disability index (SPADI). Nerve-conduction study (NCS) was done pre-operatively and 3months post-operatively for assessment of SAN. Neck dissection quality of life questionnaire (NDQOL) was used as a quality-of-life measure. A total of 65 neck dissections were included in the analysis (33 in group A and 32 in group B) out of which 53 were males and 12 were females. The mean AAS on the 6th post-operative month in group A was significantly lower than that of group B (p = 0.01). The mean SPADI scores on the 6th post-operative month was significantly worse in group A than group B (p value 0.01). On NCS, a significant decrease in amplitude was seen in group A (p = 0.02) and a significant increase in latency was noted in group B (p = 0.005). Quality of life score on 6th post-operative month showed no significant difference between both the groups (p > 0.05). Level V dissection in MRND is associated with higher incidence and greater severity of shoulder dysfunction. AAS and SPADI score are useful tools in post operative follow up of shoulder dysfunction. NCS helps in the detection of neuropathy and to determine its severity. Early rehabilitation promotes long term recovery.

Primary Malignant Melanoma of Tongue: Rare and Aggressive Malignant Tumor.

Primary melanoma of the oral cavity is extremely rare, accounting for 0.2-8% of all melanomas. Lesions arising from mucosal melanocytes occur most frequently on the gingiva or palate. Mucosal melanomas carry a worse prognosis than cutaneous melanomas. Very few studies have been published due to rarity of disease. 46 year old lady presented with black colored lesion over left side of her tongue for 6 weeks. On examination there was 3 × 2.5cm black colored patch over left lateral part of tongue in middle 1/3rd, not crossing midline. Tip and base of tongue were free. Biopsy was suggestive of malignant melanoma of tongue. Patient underwent surgery (wide local excision of left lateral border of tongue lesion + left selective neck dissection). Final Histopathological report revealed malignant melanoma of tongue with all margins free, Depth of invasion 3mm, Lympho-vascular invasion present, and no perineural invasion, left level III cervical lymph node metastases. Patient thus received adjuvant RT. Immunotherapy was also advised in multidisciplinary clinic, but patient was non-compliant. Early diagnosis will be promoted by careful oral examination and early biopsy of pigmented and non-pigmented masses. Early diagnosis and treatment will improve the prognosis of patients with oral malignant melanoma.

Upfront Neck Dissection for Treatment Selection and Improvement in Quality of Life as a Novel Treatment Paradigm for Deintensification in HPV+ OPSCC.

Locoregionally advanced HPV+ oropharyngeal squamous cell carcinoma (OPSCC) has excellent cure rates, although current treatment regimens are accompanied by acute and long-term toxicities. We designed a phase II deescalation trial for patients with HPV+ OPSCC to evaluate the feasibility of an upfront neck dissection to individualize definitive treatment selection to improve the quality of life without compromising survival. Patients with T1-3, N0-2 HPV+ OPSCC underwent an upfront neck dissection with primary tumor biopsy. Arm A included patients with a single lymph node less than six centimeters, with no extracapsular spread (ECS) and no primary site adverse features underwent transoral surgery. Arm B included patients who had two or more positive lymph nodes with no ECS, or those with primary site adverse features were treated with radiation alone. Arm C included patients who had ECS in any lymph node and were treated with chemoradiation. The primary endpoint was quality of life at 1 year compared with a matched historical control. Thirty-four patients were enrolled and underwent selective neck dissection. On the basis of pathologic characteristics, 14 patients were assigned to arm A, 10 patients to arm B, and 9 to arm C. A significant improvement was observed in Head and Neck Quality of Life (HNQOL) compared with historical controls (-2.6 vs. -11.9, P = 0.034). With a median follow-up of 37 months, the 3-year overall survival was 100% and estimated 3-year estimated progression-free survival was 96% [95% confidence interval (CI), 76%-99%]. A neck dissection-driven treatment paradigm warrants further research as a deintensification strategy.

Pattern of regional recurrence after selective neck dissection for clinically positive neck in mucosal squamous carcinoma.

Selective neck dissection (SND) has traditionally been applied to clinically negative (cN0) necks in mucosal squamous cell carcinoma (SCC). We aimed to examine the oncological safety and patterns of regional recurrence (RR) of SND in clinically positive (cN+) necks. Retrospective review of prospective cohort of 206 patients with mucosal SCC undergoing neck dissection. RR was classified as occurring within previously dissected levels, within ipsilateral undissected levels, within unusual locations of ipsilateral neck, or contralateral neck. Seven of seventy-seven (9.1%) cN+ patients undergoing SND developed isolated RR, versus 16.2% after MRND, and 8.7% after SND for cN0 disease. RR was rarely seen within undissected levels of the ipsilateral neck. RR and survival rates were not associated with ND extent (SND vs. MRND) among either cN+ or pN+ patients. SND can be safely performed in most patients with cN+ SCC, who do not have gross sternocleidomastoid infiltration or level V metastases.

PET-CT-based resection guide for treatment of auricular squamous cell carcinoma: an innovative clinical management of soft tissue tumors: a case report

PurposeTo describe the successful use of a PET-CT-based resection guide for the treatment of auricular squamous cell carcinoma.Case presentationA 69-year-old male presented with a painless growing mass in his left ear helix that had been unsuccessfully treated conservatively by another surgeon. An incisional biopsy revealed moderately differentiated squamous cell carcinoma, and the patient was referred to the department for further management. A PET/CT was performed, which showed uptake of FDG in the ear with a SUV max value and T3N0M0 status. The treatment plan was based on a multidisciplinary team discussion and a thorough evaluation of the PET/CT imaging findings. A decision was made to proceed with excision of the mass with a wide safety margin, using a PET/CT-based resection guide for ear resection. Additionally, partial temporal bone resection, selective neck dissection, and superficial parotidectomy were planned. The patient opted for reconstruction with a scalp rotational flap. The patient’s treatment plan was successful, and at follow-up visits, he remained disease-free. This case report highlights the importance of using a PET-CT-based resection guide for the treatment of soft tissue tumors, specifically auricular squamous cell carcinoma. It also demonstrates the importance of a multidisciplinary team approach and thorough evaluation of imaging findings in determining an effective treatment plan for patients.ConclusionsThe use of PET-CT-based resection guide can be an effective tool in the treatment of auricular squamous cell carcinoma. It can provide more precise and accurate information about the extent of the tumor, leading to a more effective treatment plan. Multidisciplinary team approach and thorough evaluation of imaging findings are crucial in determining the best course of treatment for patients.

Reliability and outcomes of lymph nodes biopsy in cT1-cT2 N0 supraglottic laryngeal squamous cell carcinoma.

In oral and oropharyngeal squamous cell carcinoma (SCC), sentinel node biopsy (SNB) was described as a reliable and reproductive alternative to elective neck dissection for the staging of clinical N0 T1-T2 patients. The SNB technique in supraglottic laryngeal SCC was successfully described in small series. The aim of this study is to analyze retrospectively the results of SNB technique in supraglottic SCC in CHU Godinne, to determine if the technique is reliable and may be proposed in a future multicentral prospective trial. The study involved a retrospective analysis of 39 patients who underwent surgery between 2003 and 2019 at CHU Godinne. All patients presented with clinical N0 neck status. The SNB procedure included general anesthesia, 99-technetium colloid peritumoral injection, and lymphoscintigraphy. The hand-held gamma probe was utilized for SNB after tumoral resection during the same operating session. Out of 39 patients, 36 underwent SNB as the sole staging tool, while 3 patients received SNB in combination with elective neck dissection. Primary outcome was the 2-years neck recurrence-free survival (RFS). Secondary outcomes were the 2- and 5-years disease-specific survival (DSS). Additionally, sensitivity and negative predictive value (NPV) of the SNB technique were analyzed. Sentinel nodes were successfully identified in all 39 patients. An average of 4 nodes excised per patient. Positives SN were detected in 23% (9 in 39) cases, leading to subsequent selective neck dissection. Two cases of neck recurrence were observed, both considered as false negatives, occurring after an average of 3.5 months. Th median follow-up period was 48 months with a 2-year RFS of 95%. Sensitivity and NPV of the SNB technique were found to be 82% and 94%, respectively. Two and five years DSS were 84% and 71.7%, respectively. The results suggest that SNB in T1-T2 supraglottic SCC is a feasible and reliable technique for managing the neck in N0 early-stage patients. However, to establish its oncological equivalence with selective node dissection, further prospective and comparative studies are warranted. The findings of this study underscore the importance of ongoing research in refining and validating the role of SNB in the management of supraglottic SCC, potentially paving the way for more widespread adoption in clinical practice.

Factors Affecting Drain Output in Oral Carcinoma.

Advanced oral carcinoma surgery results in large denuded areas leading to seroma and hematoma. Closed suction drains obliterate dead space and create negative pressure on wound bed. Non-placement or early removal of drain can lead to various complications, while placement for long duration can cause surgical site infection. The study aims to evaluate factors affecting postoperative neck drain volume, guiding surgeons for decision making for time of drain removal. The study comprised of 222 patients with oral squamous cell carcinoma who underwent primary tumor resection and neck dissection. Demographical, clinical, and surgical details were retrospectively analyzed. The mean age of patients was 49.1 years. Majority of patients had advanced disease requiring extensive surgery. Patients with radical neck dissection and those reconstructed with pedicled flap had statistically significant drain volume as compared to those with selective neck dissection and free flaps, respectively. Patients with longer duration of surgery, higher blood loss, low postoperative albumin value, and complications showed increased drain volume. Mean duration of drain removal was 7 days, and all drains were removed by day 10. Advanced stage primary disease, radical and modified neck dissections, PMMC flap reconstruction, longer duration of surgery, and higher blood loss had higher drain output. Thus, patient parameters, tumor factors, and surgery factors influence drain output and hospitalization. Diligent preoperative and perioperative assessment of various factors can aid trainee surgeons to make decisions for appropriate time for drain removal.