Yonsei Med J.  2013 Jan;54(1):139-144. 10.3349/ymj.2013.54.1.139.

Selective Neck Dissection for Clinically Node-Positive Oral Cavity Squamous Cell Carcinoma

• Shin YS
• Koh YW
• Kim SH
• Choi EC

• KMID: 1776929
• DOI: http://doi.org/10.3349/ymj.2013.54.1.139

Abstract

PURPOSE
The treatment of a clinically node-positive (cN+) neck is important in the management of oral cavity squamous cell carcinoma (OSCC). However, the extent of neck dissection (ND) remains controversial. The purpose of our study was to evaluate whether level IV or V can be excluded in therapeutic ND for cN+ OSCC patients.
MATERIALS AND METHODS
We performed a retrospective chart review of 92 patients who underwent a comprehensive or selective ND as a therapeutic treatment of cN+ OSCC from January 1993 to February 2009.
RESULTS
The incidence rate of metastasis to level IV or V was 22% (16 of 72) on the ipsilateral neck. Of 67 cases without clinically suspicious nodes at level IV or V, 11 cases (16%, 11 of 67) had pathologically proven lymphatic metastasis to level IV or V. Only a nodal staging above N2b was significantly relevant with the higher rate of level IV or V lymph node metastasis (p=0.025). In this series, selective ND, combined with proper adjuvant therapy, achieved regional control and survival rates comparable to comprehensive ND in patients under the N stage of cN2a OSCC.
CONCLUSION
In conclusion, level IV and V patients can avoid recurrence under cN2a OSCC.

Keyword

Oral cavity cancer; selective neck dissection; therapeutic neck dissection; level IV; level V

MeSH Terms

Adult
Aged
Carcinoma, Squamous Cell/mortality/*pathology/*surgery
Chemoradiotherapy
Disease-Free Survival
Female
Humans
Lymphatic Metastasis
Male
Middle Aged
Mouth Neoplasms/mortality/*pathology/*surgery
Neck/surgery
*Neck Dissection
Neoplasm Metastasis
Radiotherapy, Adjuvant
Retrospective Studies
Treatment Outcome

Figure

• 

  Fig. 1 Disease-free survival and neck control rates according to neck dissection. (A) Disease-free survival. (B) Neck control rate. CND, comprehensive neck dissection; SND, selective neck dissection.

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