Therapeutic Selective Neck Dissection Research Articles

Carotid Sheath Dissection and Histopathology During Neck Dissection in Head and Neck Carcinomas.

To investigate the carotid sheath in neck dissection (ND) specimens histopathologically in patients with head and neck carcinomas who had no evidence of previous neck surgery or direct involvement of the carotid sheath in their pre- or intra-operative evaluations. In this study, carotid sheath (CS) specimens of 40 patients with head and neck carcinomas (HNCA) who, depending on the condition of the primary tumor, required unilateral or bilateral elective or therapeutic selective neck dissection were histopathologically investigated by an expert head and neck pathologist to find any lymphoid or thyroid like tissue or tumor cells infiltration. A total of 50 carotid sheath (CS) specimens were investigated. None of the samples showed any evidence of tumor infiltration or accumulation of lymphatic tissue. We conclude that in patients with no histopathologic involvement of the carotid sheath in pre-operative or intra-operative tumor invasion, it is not necessary to remove CS in routine neck dissection.

Lateral Neck Dissection for Well-Differentiated Thyroid Carcinoma: Is Prophylactic Level V Neck Dissection Necessary? A Retrospective Cohort Study.

The presence of clinically detectable papillary thyroid carcinoma (PTC) metastases in the lateral neck is an indication for neck dissection (ND) and thyroidectomy. Although there is a consensus regarding the importance of therapeutic selective ND of involved levels II to IV in patients with clinically evident locoregional metastatic disease, the prognostic benefit of level V prophylactic ND remains debatable. All patients who underwent thyroidectomy with ND for metastatic PTC between 2006 and 2019 were included in a single-institution retrospective study. Preoperative characteristics at initial presentation, imaging workup, intraoperative findings, and the final histopathological reports were retrieved from the institutional database. A total of 189 patients with locally advanced PTC were identified, of whom 22 (11.6%) patients underwent therapeutic selective ND at levels II to IV together with level V dissection due to clinical involvement. Comparison of the patients who were operated on level V to those who were not revealed no significant difference. The disease recurrence rate was 20.1% throughout an average follow-up of 5.1±3.1 years. No significant differences in recurrence rate were found between patients who underwent and those who did not undergo level V ND (22.7% vs 19.8%, P = .648). No recurrence at resected level V was detected during follow-up, while recurrence at level V was found in 4 (2.1%) patients who did not undergo level V dissection. Evidence of macroscopic and microscopic extrathyroidal extension was significant predictors of disease recurrence risk. There were no significant associations between level V dissection and risk for recurrence. Recurrence at level V was rare (4/189 patients, 2.1%). Our study's findings suggest a low prophylactic benefit of an elective level V ND. Elective level V ND should not be done routinely when lateral ND is indicated but should rather be considered after careful evaluation in high-risk patients.

Regional Control of Head and Neck Melanoma with Selective Neck Dissection

Objective: Historically, patients with cervical metastases from melanoma of the head and neck were treated with a modified radical or radical neck dissection. The purpose of our study was to evaluate the efficacy of therapeutic selective neck dissection (SND) in this high-risk population. Method: Retrospective, single-cohort study from a prospective institutional database. Patients underwent therapeutic SND for clinically node positive head and neck melanoma (n = 14) or pathologically node positive disease after sentinel lymph node biopsy (SLNB) (n = 27). Univariate and multivariate analyses were conducted. Primary end points were regional recurrence and regional recurrence free survival. Results: Forty-one patients underwent therapeutic SND from 2001 to 2010. The median number of positive nodes was 1 (range, 1-16 months). Twenty-six patients (63%) received adjuvant radiation and 23 patients (56%) received adjuvant immunotherapy or chemotherapy. The median follow-up time was 17 months (range, 1-116 months). Regional control was achieved in 29 patients (71%). Median regional recurrence-free survival was 21 months (range, 1-116 months). Advanced age was a significant predictor of regional recurrence ( P = .012) while tumor depth, extracapsular spread, number of nodes positive, prior SLNB, extent of neck dissection, adjuvant radiotherapy, and adjuvant immunotherapy were not significant. Conclusion: Therapeutic SND with frequent use of adjuvant radiation therapy is effective in achieving regional control of head and neck melanoma with cervical metastases. Older patients may be at increased risk of regional recurrence after SND for head and neck melanoma.

Therapeutic selective neck dissection (level II–V) for node-positive hypopharyngeal carcinoma: is it oncologically safe?

Conclusions. Our study suggests that routine level I dissection may not be necessary in the surgical management of clinically N + hypopharyngeal squamous cell carcinoma (SCC) in patients who do not have a positive lymph node in neck level I. Objective. To determine whether level I lymph node dissection can be saved in patients with clinically N + hypopharyngeal SCC. Patients and methods. Retrospective analysis of 64 consecutive clinically N + patients with untreated hypopharyngeal SCC between 1994 and 2006. Forty-seven patients underwent level I lymph node dissection and the remaining 17 did not. Forty-five of the 64 patients were followed for a minimum of 2 years, if alive, or until death. Of these 45 patients, 35 underwent ipsilateral level I dissection of the neck. Results. The incidence of occult metastases to level I was 6% (3 of 47). Six (17%) of 35 patients with level I dissection and 1 (10%) of 10 patients without level I dissection experienced regional recurrence (p>0.05). The 2-year disease-specific survival in 47 patients undergoing level I neck dissection was 44% compared with 37% in 17 patients who did not undergo level I neck dissection (p>0.05).

Effectiveness of selective neck dissection in the treatment of the clinically positive neck

The aim of this work was to determine whether or not patients treated with therapeutic selective neck dissection for head and neck squamous cell carcinoma were oncologically disadvantaged compared with those having comprehensive procedures. The study involves a retrospective review of 232 therapeutic neck dissections with a minimum of 2 years follow-up. Patients having selective neck dissection had fewer adverse prognostic factors compared with patients having comprehensive dissection (pN2/3, p = .001; and extracapsular spread, p = .001). There were trends toward improved control in the dissected neck (96% vs 86%, p = .06), and disease-specific survival (59% vs 43%, p = .06) following selective neck dissection. Disease-specific survival for all patients was adversely affected by pN classification (p <.001) and extracapsular spread (p <.001). Patients undergoing aggressive neck surgery had more extensive disease. Selective neck dissection can be used to effectively treat clinically positive nodal disease in selected patients.

Neck treatment of patients with early stage oral tongue cancer

The role of elective and therapeutic selective neck dissection in patients with early stage cancer of the oral tongue remains controversial. The purpose was to investigate the role of neck treatment in the management of this condition. A total of 380 patients with cT1-2N0 oral tongue cancer were retrospectively reviewed. Patients were staged by means of computed tomography (CT) or magnetic resonance imaging (MRI) scans. A total of 324 patients received elective neck dissection (END), whereas 56 participants received observation (OBS). In all, 287 patients received supraomohyoid neck dissection (SOND), whereas 37 patients received modified radical neck dissection (MRND). Overall survival (OS) and neck control rates (NCR) were investigated according to the treatment modality. In the END group the occult metastasis (OM) rates in cervical lymph nodes were 5.2% for cT1 lesions and 14.6% for cT2 lesion (P = .005). The 5-year OS (P = .029) and NCR rates (P = .001) were significantly better in the END group compared with the OBS group. Patients who received MRND had a better 5-year NCR compared with SOND, albeit not significantly (91.4% vs 85.3%, P = .415). Multivariate analysis showed that END and stage were independent predictors of both NCR and OS. END should be performed routinely in patients with early-stage oral tongue cancer, even in the presence of negative neck by CT scans and MRI.

Total thyroidectomy in the treatment of thyroid carcinoma in childhood.

Between 1974 and 1993 ten girls and six boys aged 6-16 years underwent total thyroidectomy, with therapeutic selective neck dissection in six patients. All were treated after operation with radioactive iodine (131I) for ablation of thyroid tissue remnants. Papillary carcinoma occurred in ten patients, follicular carcinoma in two and medullary thyroid lesions in four. The patients were followed for a median of 11.5 (range 1-20) years with regular determinations of serum thyroglobulin levels and 131I whole-body scanning when indicated. Only one patient had a slight increase in thyroglobulin levels without evidence of disease on further screening. In children with medullary lesions the serum levels of basal and pentagastrin-stimulated calcitonin remained normal. Currently all patients are alive and without disease. Hypocalcaemia lasting for more than 1 year was observed in one patient. Recurrent nerves were not injured accidentally, but because of tumour invasion two of 32 recurrent nerves had to be sacrificed. This surgical approach is safe and well tolerated in children.

536 Total thyroidectomy in the treatment of thyroid carcinoma in childhood

The extent of surgical resection for thyroid cancer in children up to the age of 16 years is controversial with a morbidity varying between 15 and 90%. Between 1974 and 1993 we routinely performed total thyroidectomy in 16 consecutive patients, ten girls and six boys (6–16 years) with a therapeutic selective neck dissection in six patients. All patients were treated with 131J postoperatively. The results and morbidity were evaluated. Papillary carcinoma was present in 10, follicular carcinoma in 2 and medullary lesions were seen in 4 patients. Extrathyroidal extension was observed in 4 of the 12 patients. Nodal metastases were found at level II–IV1 in 6 patients and at level V in 2. With an average of 11.5 (2–20) years, all patients were followed regularly with serum thyroglobulin (Tg) and 131J total body scanning when indicated. Only one patient has a slight elevation of Tg levels without any evidence of disease at screening. All patients are alive with no demonstrable recurrences. Only one patient had a long-lasting hypocalcaemia (>1 year). Recurrent nerves at risk were not injured accidentally, but due to tumour invasion 2 of the 32 nerves at risk had to be sacrificed. These findings indicate that this surgical approach is safe and well tolerated in pediatric patients. Robbins KTh, et al. Standardizing neck dissection terminology. Arch Otolaryngol Head Neck Surg 1991; 117:601. The extent of surgical resection for thyroid cancer in children up to the age of 16 years is controversial with a morbidity varying between 15 and 90%. Between 1974 and 1993 we routinely performed total thyroidectomy in 16 consecutive patients, ten girls and six boys (6–16 years) with a therapeutic selective neck dissection in six patients. All patients were treated with 131J postoperatively. The results and morbidity were evaluated. Papillary carcinoma was present in 10, follicular carcinoma in 2 and medullary lesions were seen in 4 patients. Extrathyroidal extension was observed in 4 of the 12 patients. Nodal metastases were found at level II–IV1 in 6 patients and at level V in 2. With an average of 11.5 (2–20) years, all patients were followed regularly with serum thyroglobulin (Tg) and 131J total body scanning when indicated. Only one patient has a slight elevation of Tg levels without any evidence of disease at screening. All patients are alive with no demonstrable recurrences. Only one patient had a long-lasting hypocalcaemia (>1 year). Recurrent nerves at risk were not injured accidentally, but due to tumour invasion 2 of the 32 nerves at risk had to be sacrificed. These findings indicate that this surgical approach is safe and well tolerated in pediatric patients. Robbins KTh, et al. Standardizing neck dissection terminology. Arch Otolaryngol Head Neck Surg 1991; 117:601.