What is optimum neck dissection for T3/4 buccal-gingival cancers?

Buccal-gingival (BG) cancers are an integral part of oral cancers but are biologically distinct, particularly with regard to the propensity and pattern of neck metastases. This study was undertaken to examine the adequacy of limited neck dissection in the management of these tumors. Between 1980 and 1989, 527 T3/4 BG cancers were treated surgically at Tata Memorial Hospital, Bombay. These cases were reviewed retrospectively. Among these, 178 underwent radical neck dissection (RND), 166 supradigastric dissection (SD) and 183 supraomohyoid dissection (SOHD) after confirming the negativity of levels II and III for nodal disease on frozen section. The overall incidence of histological node positivity was 42.5% (224/527). Level I was the most frequent site of metastases, with a skip rate of only 9%. The incidence of pure regional failure (primary controlled) was 3% with RND (67/178),12% with SD (11/95) and 5% with SOHD (7/141) in patients with N0 necks. In the N+ category the regional failure was 18% with RND (20/111), 34% with SD (24/71) and 19% with SOHD (8/42). These findings show that a limited (SD) dissection is grossly inadequate in the management of T3/4 BG cancers, whereas an SOHD when neck levels 11 and III are confirmed negative on frozen section yields results comparable to RND for both NO and N+ necks.Presented at the combined meetings of the Society of Head and Neck Surgeons and the European Organization for Research and Treatment of Cancer, Paris, France, 25–28 May 1994     

CO2激光手术治疗声门上型喉癌

目的 总结CO2激光手术治疗声门上型喉癌的临床治疗效果.方法 回顾性分析1995年2月至2005年6月CO2激光手术治疗的32例声门上型喉癌患者临床资料.32例患者中T1N0M0 20例,T1N1M0 2例,T2N0M0 8例,T2N1M0 2例,全部病例术后随诊3年以上.喉部肿瘤均经口行激光手术,同期行择区性(Ⅱ-Ⅳ区)颈清扫术12例,改良全颈清扫术4例.结果 KaplanMeier法统计5年生存率为90.6%,其中T1病变5年生存率为95.6%,T2病变为78.2%.喉的局部控制率为96.8%;喉局部和颈部区域5年控制率为90.3%,其中T1病变5年局部区域控制率为90.9%,T2病变为89.0%.喉部局部复发2例,1例再治疗行喉水平垂直部分切除术,1例行喉全切除术.颈部区域复发2例,其中1例喉部复发伴颈淋巴转移,再治疗后存活;1例颈部复发,治疗后再次颈部复发并伴肺转移死亡.4例患者出现较轻并发症,保守治疗后好转.除1例患者因局部复发行喉全切除外,其余存活患者喉功能良好.结论 激光治疗早期声门上型喉癌创伤小、疗效可靠,是一种理想的治疗方式.     

择区性颈清扫术在临床N0舌鳞状细胞癌治疗中的应用

目的比较择区性颈清扫术(selective neck dissection，SND)与经典性或改良性颈清扫术(radical neck dissection，RND)在治疗舌鳞状细胞癌颈淋巴结临床阴性(cN0)患者中的效果。方法将1998年1月-2002年12月之间采用肩胛舌骨肌上颈清扫术(Ⅰ～Ⅲ区)14例及Ⅰ～Ⅳ区清扫19例(SND组)共33例与1980年1月-1997年12月之间112例采用经典性或改良性颈清扫术(RND组)的病例，根据T分期、综合治疗方式和淋巴结病理情况进行随机配对分析。Kaplan—Meier方法计算复发率和颈部淋巴结复发或生存趋势。结果RND组5年颈部复发率为9．1％(3例)，SND组5年同侧颈部复发率12．1％(4例)；两组的5年生存率分别是78．8％和82．9％(分别为26例和28例)。Ⅰ-Ⅲ区清扫组5年颈部复发率为21．2％(3例)，清扫野外复发率为14．3％(2例)；Ⅰ-Ⅳ区清扫组5年同侧颈部复发率5．3％(1例)，清扫野外复发率为0。结论与经典性或改良性颈清扫术相比，择区性颈清扫术并不影响cN0舌癌患者的肿瘤治疗效果，术式以Ⅰ～Ⅳ区清扫为适宜。     

颈侧清扫术与颈根治性清扫术治疗声门上型喉癌的疗效对比

目的　对比颈侧清扫术 (lateralneckdissection ,LND)与根治性或改良根治性颈清扫术(radicalneckdissection ,RND)在治疗喉癌声门上型颈淋巴结病理阴性 (pN0 )患者中的效果。方法回顾性分析中国医学科学院中国协和医科大学肿瘤医院头颈外科治疗的喉鳞状细胞癌声门上型pN0患者。对照的两组患者分别是 39例 1980年 3月～ 1996年 12月之间采用根治性或改良根治性颈清扫术治疗的患者 (RND组 ) ;4 5例 1997年 1月～ 2 0 0 1年 12月之间采用颈侧清扫术患者 (LND组 )。结果　LND组 5年颈部淋巴结转移率为 2 3% ,RND组 5年颈部淋巴结转移率 0 ,无统计学意义 (P =0 347) ;两组的 5年生存率分别是 97%和 94 % ,无统计学意义 (P =0 6 13)。但是 ,LND组与颈清扫术有关的并发症显著的低于RND组 (6 7%和 38 5 % )。此外 ,LND组较RND组缩短了 11d平均外科住院时间 (2 8d和 39d)。结论　与根治性或改良性颈清扫术相比 ,采用颈侧清扫术并不影响pN0喉癌声门上型患者的肿瘤治疗效果 ,但却减少了损伤 ,降低了并发症 ,缩短了住院时间。     

Controlling advanced neck disease: efficacy of neck dissection and radiotherapy

OBJECTIVE: Neck dissection remains the standard method of treating cervical metastasis from head and neck squamous cell carcinoma. In light of recent trends to modify the classic radical neck dissection (RND) for early neck disease, we reviewed our experience with radical and modified RND (MRND) plus radiotherapy as treatment for N2/N3 neck disease in head and neck squamous cell carcinoma. METHODS: We retrospectively reviewed our clinical records from July 1989 to June 1996 to identify 43 neck dissections in 39 patients who were found to have pathologically N2 or N3 neck disease treated primarily by neck dissection and postoperative radiotherapy. All patients had head and neck squamous cell carcinoma with a minimum follow-up of 24 months. RESULTS: Nine percent (4/43) of the dissected necks were pathologically N2a, 72% (31/43) were N2b, 7% (3/43) were N2c, and 12% (5/43) were N3. Of these, 28% (12/43) underwent a RND and 72% (31/43) underwent a MRND. The most common modification of RND was preservation of the spinal accessory nerve. All patients underwent postoperative radiotherapy with a mean dose of 55 Gy. Only 4 of 43 dissected necks had isolated treatment failure, for a regional control rate of 91%. CONCLUSIONS: The combination of RND or MRND and radiotherapy is highly effective in controlling neck disease in the absence of persistent or recurrent local disease. Also, in our experience, MRND appears to be as effective as RND in controlling even advanced neck disease, which supports preservation of the spinal accessory nerve whenever oncologically feasible.     

Supraglottic laryngeal cancer: analysis of treatment results

OBJECTIVE: This study reports the results of treatment for supraglottic laryngeal cancer with nine different treatment modalities with long-term follow-up. STUDY DESIGN: Retrospective study of 653 patients with supraglottic laryngeal squamous cell cancer treated from April 1955 to January 1999. METHODS: The study population included previously untreated patients with cancer of the supraglottic larynx treated with curative intent by one of nine treatment modalities and who were eligible for 5-year follow-up. The treatment modalities included subtotal supraglottic laryngectomy (SSL), SSL with neck dissection (SSL/ND), total laryngectomy (TL), TL/ND, radiation therapy (RT), SSL/RT, SSL/ND/RT, TL/RT, and TL/ND/RT. Multiple diagnostic, treatment, and follow-up parameters were studied using standard statistical analysis to determine significance. RESULTS: None of the nine treatment modalities produced a survival advantage, either overall or within the stages. Overall disease specific survival (DSS) by treatment modality included SSL 88.9%, SSL/ND 75.8%, TL 83.3%, TL/ND 66.7%, RT 47.2%, SSL/RT 68.9%, SSL/ND/RT 68.1%, TL/RT 59.3%, and TL/ND/RT 46.7%. Improved DSS and cumulative disease specific survival rates were associated with patients under the age of 65 years (P = .0001), early stage disease, N0 disease (P = .0001), clear resection margins (P = .0094), and no recurrence (P = .0001). Posttreatment function showed that 90% of patients were functional in everyday life, 90.7% were eating satisfactorily, 91.4% were breathing naturally, and 83% of SSL patients, 85.7% of RT patients, and 52.8% of TL patients had "good" voices. Laryngeal preservation was accomplished in 86.1% of SSL patients and 72.7% of RT patients (P = .0190). CONCLUSIONS: No treatment modality produced a survival advantage. Because SSL produced the best rate of laryngeal preservation, we recommend its use in treating the primary in eligible patients. The importance of clear resection margins is stressed. Patients with N+ disease should have the neck treated. Patients with N0 disease may be observed safely with no loss of survival advantage. Because of the pattern of recurrence and the high rates of distant metastasis and second primary cancers, follow-up for a period of not less than 8 years is recommended.     

Management of the N0 Neck During Salvage Laryngectomy

Background: Radiotherapy is effective treatment for laryngeal carcinoma. Early-stage laryngeal carcinoma has a low incidence of cervical metastasis. Patients initially clinically N0 usually remain N0 when they fail at the primary site. The incidence of subclinical metastasis in these patients is not well described. Watchful waiting or elective neck dissections are advocated. Objective: Examine the incidence of subclinical metastatic disease in patients undergoing elective neck dissections with salvage laryngectomy. Study Design: Prospective study (1991–1996) of patients who failed radiotherapy and underwent salvage laryngectomy with elective neck dissection. Methods: Thirty-four patients underwent salvage laryngectomy with neck dissection (30 bilateral, 4 unilateral). All were clinically N0 at initial presentation and remained N0 at recurrence. Pathologic study of the neck dissection specimens was undertaken. Patients were followed for a minimum of 2 years (mean, 4 y). Results: The male-to-female ratio was 4.5:1, with a mean age of 62 years (range, 38 to 75 y). Metastatic disease was present in 6 patients (17%); 4 of 14 (28%) supraglottis and 2 of 20 (10%) glottic. Presence of disease in the neck according to stage at recurrence was as follows: T2, 2 of 12; T3, 3 of 14; and T4, 2 of 8. Neck disease was ipsilateral in 4 and contralateral in 2 patients (both supraglottic primaries). Conclusions: Subclinical cervical metastasis may be present in N0 laryngeal carcinoma patients who have recurrence following radiotherapy. Morbidity of a lateral neck dissection is minimal, with excellent control of the neck being possible. Supraglottic and advanced glottic (T3-T4) patients may benefit the most.     

Upper neck (level II) dissection for N0 neck supraglottic carcinoma

OBJECTIVES: Elective neck dissection for the N0 neck in head and neck surgery is still controversial. This prospective nonrandomized study of N0 supraglottic carcinoma was designed to find an appropriate method of neck management. STUDY DESIGN: Anatomical studies show that the first echelon of lymphatic drainage from the supraglottic larynx is toward the upper jugular nodes (level II). An upper neck dissection (UND) was applied and all the lymph nodes were sent for frozen section. If the subclinical metastasis was found, a modified neck dissection was performed. If the nodes harbored no foci of cancer, the patients were observed after surgery on the supraglottic lesions. METHODS: Patient records of 142 patients with supraglottic laryngeal cancer (T1-4N0M0) were reviewed, with special attention paid to neck recurrences and survival rates. The cases were treated between 1976 and 1990 and all were observed for at least 5 years after the operation or until the time of death. RESULTS: The UND specimens of 142 patients were negative for metastasis. The 5-year survival rate for this group after surgery was 80.8%, according to the life table analysis. Fifteen of the 142 patients (10.6%) had neck recurrences during the period of observation within 5 years. The recurrence rate of this series with limited dissection on the neck was comparable with those reported in the literature after neck dissection, either radical or modified. CONCLUSIONS: There is no need for a comprehensive neck dissection for N0 supraglottic laryngeal cancer. A selective neck dissection such as UND (level II) or a supraomohyoid neck dissection (sparing the submandibular region) of level II and III will serve the purpose of radical neck treatment for the supraglottic cancer.     

声门上型喉癌颈淋巴隐匿性转移及其处理

目的 探讨声门上型喉癌颈淋巴隐匿性转移规律及其处理方法。方法 选择术前未行放疗、化疗的声门上喉鳞状细胞癌，临床N0M0病例，共30例，男19例，女11例；年龄40～72岁，平均54．8岁；按UICC(1997年)标准分期1、28例，1318例，T44例。行主病变侧肩胛舌骨肌上颈清扫术(supraomohyoid neck dissecton，SOHND)，将获得淋巴结逐一行病理组织学检查，观察其转移规律及临床治疗效果。结果 首次颈清扫术30例中有6例颈淋巴结转移癌阳性，在2～3年随访中有3例发生对侧颈淋巴结转移，计有9例颈淋巴转移，隐匿性转移率同侧为20％(6／30)，对侧为10％(3／30)。颈清扫术共获淋巴结527个，平均每侧17．6个。获转移阳性淋巴结10个，其中Ⅱ区9个，Ⅲ区1个，Ⅰ区无癌转移。喉及主病变侧颈部均无复发，2年无瘤生存率86．7％(26／30)。结论 声门上型喉癌颈淋巴结隐匿性转移率达30％，采用Ⅱ、Ⅲ区的择区性颈清扫术处理其颈淋巴结(Ⅰ区可不必作为常规清扫区域)是切实可行的。     

改良性颈廓清术在声门上型喉癌患者中的应用

目的 :为提高声门上型喉癌患者的生存率和生存质量 ,总结颈廓清术中保留颈内静脉的临床经验。方法 :88例声门上型喉癌患者中 ,在原发灶切除同时 ,共进行 146侧 (双侧 116例 ,单侧 30例 )颈廓清术 ,其中改良颈廓清 (MND)10 6侧 ,根治颈廓清 (RND) 4 0侧。双颈廓清术 5 8例 ,其中同期双颈廓清 32例 ,18例保留双侧颈内静脉 ,14例保留一侧颈内静脉 ;分期双颈廓清 2 6例 ,第一次均为 RND,第二次均为 MND。 30例行一侧颈廓清术 ,术中均保留颈内静脉。结果 :患者 3年生存率同期双颈廓清 81.5 % (2 2 / 2 7) ,分期双颈廓清 6 0 .9% (14/ 2 3) ,一侧颈廓清 75 % (15 / 2 0 )。5年生存率同期双颈廓清 6 1.5 % (16 / 2 6 ) ,分期双颈廓清 40 .9% (9/ 2 2 ) ,一侧颈廓清 70 .6 % (12 / 17)。 MND最大淋巴结直径≤ 3cm,术后复发率 12 .9% (11/ 85 ) ,>3cm者复发率为 47.6 % (10 / 2 1) ,总复发率为 19.8% (2 1/ 10 6 )。 RND术后颈淋巴结复发率为2 2 .5 % (9/ 40 )。结论 :声门上型喉癌常有双颈淋巴结转移 ,需行双颈廓清术 ,并必须保留一侧颈内静脉。在淋巴结小于3cm ,肉眼观与颈内静脉无粘连时保留颈内静脉 ,不增加淋巴结复发率 ,减少并发症 ,并提高生存质量。     

Extended and standard supraglottic laryngectomies: a review of 110 patients

The purpose of this study was to compare functional and oncological results of extended and standard supraglottic laryngectomies. One hundred ten patients with supraglottic carcinoma were treated. A standard supraglottic laryngectomy (SSL), a laterally extended supraglottic laryngectomy (LESL) and an anteriorly extended supraglottic laryngectomy (AESL) were performed on 32, 47 and 31 patients, respectively. Indications for postoperative radiotherapy included positive surgical margins (23% of patients) and/or node metastasis (63% of patients). Local recurrence occurred in 13% of SSL, 15% of LESL and 17% of AESL patients. Pulmonary complications due to aspiration were observed in 6% of SSL, 15% of LESL and 19% of AESL. The overall 5-year cure rates were 63% for SSL, 45% for LESL and 47% for the AESL procedures. Extended supraglottic laryngectomies provided as good a local tumor control as SSL. Extension to the hypopharynx (LESL) and to the vallecula (AESL) showed more frequent pulmonary complications and reduced cure rates.     

喉癌和下咽癌颈淋巴结转移临床对比分析

目的：探讨喉癌、下咽癌患者颈淋巴结转移的特点和分布规律。方法：对全喉切除术同期及复发后第1次行颈淋巴结清扫的129例喉癌、下咽癌患者的临床资料进行回顾性对比分析，研究不同类型的喉癌、下咽癌患者颈淋巴结的转移情况。结果：声门上型喉癌、下咽癌患者易发生早期淋巴结转移；下咽癌患者的转移淋巴结融合率高，颈静脉下区出现阳性淋巴结的比率高；声门上型喉癌、下咽癌患者原发病灶分化差的比率相对偏高；同期与复发后行颈淋巴结清扫的患者原发病灶分期差异无显著性意义。结论：对T2期及以上的声门上型喉癌及下咽癌患者，尤其当细胞分化比较差时，即使颈淋巴结阳性体征不明显亦应积极考虑颈淋巴结清扫问题，对下咽癌患者行颈淋巴结清扫时应考虑彻底清扫颈静脉下区的淋巴结。     

Results of treatment of 584 laryngeal cancers at the Ear-Nose-Throat Clinic of Marburg University

The results in the management of 460 vocal cord carcinomas and 124 supraglottic carcinomas are reported. Of the vocal cord carcinomas, 63.3% were diagnosed in the early Tis and T1 stage. Seventy-six tumors were resected endoscopically, 128 by laryngofissure and chordectomy. Not one of these patients has lost his life, larynx or voice. In bilateral tumors of the T1b category, 2 patients developed local recurrences and lost their larynx. Sixty-two carcinomas of the Tis, T1a and T1b categories were irradiated primarily. Two of these patients died and 14 underwent laryngectomy for local recurrence. In T2 carcinomas a 5-year cure rate of 87.5% was achieved by vertical partial resection. The 5-year cure rate after laryngectomy or laryngectomy with neck dissection for T2N0 and T2N+ carcinoma was 86.2% and 75.0% respectively. Most treatment failures were due to late metastases which could not be controlled. In T3 carcinomas with a 5-year cure rate of 71.4% (N0) and 70.0% (N+) respectively, treatment failures were also mainly seen in patients with N0 necks where we did not carry out a prophylactic neck dissection. Five-year survival rates for primary surgery in supraglottic T1-T4 carcinomas were 100%, 82.4%, 84% and 58.3%. The widely hel opinion that laryngeal carcinoma should only be subjected to surgery for irradiation failure can no longer be sustained. More patients lose their larynx or their life after irradiation of small carcinomas than after primary surgery. Furthermore, too many patients have to undergo two major cancer treatments (irradiation and salvage surgery). In larger carcinomas radiotherapy produces a lower survival rate and too many patients require two stressful cancer therapies. The number of retained larynges is not substantially higher than with primary surgery. Primary irradiation for selected cases should be part of every therapy concept that aims at an adequate and individual treatment of every patient.     

声门上癌术后颈淋巴结的转移与再发

探讨选择性颈廓清术在声门上癌手术治疗中的作用。方法总结１９８１－１９９３年治疗的５８２例声门上癌术后颈淋巴结转移及廓清侧转移淋巴结再发情况。结果Ｔ３、Ｔ４病例３９２例,而Ｔ３Ｎ＋、Ｔ４Ｎ＋１４７例。     

The effect of midline crossing of lateral supraglottic cancer on contralateral cervical lymph node metastasis

Conclusion: The degree of midline crossing of lateral supraglottic cancer does not significantly change its rate of contralateral cervical metastasis. The rate of occult metastasis is too high to take the risk of contralateral regional recurrence. We support routine bilateral neck dissection even in lateral supraglottic cancers with no or minimal midline crossing. Objectives: Data on the rate of contralateral cervical metastasis of laterally located supraglottic cancer, the effect of its degree of midline crossing on contralateral cervical metastasis, and its treatment are still controversial. Methods: This was a retrospective cohort, chart review involving 305 surgically treated patients with T1–3 squamous cell carcinoma of the supraglottic larynx. In all, 184 patients had bilateral neck dissection; 86 N0 contralateral necks were followed up. Thirty-five patients who needed postoperative radiation therapy because of the primary tumor or ipsilateral neck dissection specimen also received radiation therapy to the contralateral neck. The degree of midline crossing at the epiglottis was measured on a laryngectomy specimen with a ruler and expressed as ‘no,’ ‘<5 mm’ or ‘≥5 mm.’ Results: The rates of occult and overall contralateral metastasis in our series were 16% and 28%, respectively. There was no statistically significant difference between contralateral neck metastasis and recurrence rates in the neck dissection, follow-up, and irradiation groups according to the degree of midline crossing.     

喉外侵犯对声门上型喉癌部分喉切除术的影响

本文回顾分析了中国医学科学院肿瘤医院1979年至1990年168例声门上型喉癌行部分喉切除术患者的临床资料,研究了喉外侵犯对声门上型喉癌水平部分喉切除术的影响,发现舌根受侵切除部分舌根使水平部分喉切除术的拔管率由92.10％降为58.82％,梨状窝受侵者切除部分梨状窝使3/4部分喉切除术的拔管率由67.39％降为33.33％(P<0.05)。梨状窝内壁受侵组的生存率低于舌根受侵组(P<0.01)。因此,将声门上型喉癌梨状窝内壁受侵定为T_4病变更合适。结论:声门上型喉癌侵及舌根及梨状窝内壁时部分喉切除术后的拔管率降低,梨状窝内壁受侵时生存率也明显降低。     

Laryngeal mucoepidermoid carcinoma: report of two cases

Mucoepidermoid carcinoma (MEC) of the larynx is a rare neoplasm, with a review of the literature having disclosed only 83 documented cases. These tumours are believed to develop from ductal elements of the submucosal glands [Gomes V, Costarelli L, Cimino G, Magaldi L, Bisceglia M. Mucoepidermoid carcinoma of the larynx. Eur Arch Otorhinolaryngol 1990;248:31-4]. The most common sites are the floor of the laryngeal ventricle, false vocal folds and anterior comissure [Alavi S, Namazie A, Calcaterra TC, Blackwell KE. Glandular carcinoma of the larynx: the UCLA experience. Ann Otol Rhinol Laryngol 1998;108:485-9]. We describe two cases of MEC of the larynx. One of them was a transglottic and the other one a supraglottic tumour. First patient was treated with total laryngectomy (TL) and right extended radical neck dissection (RND). Second case was treated with supracricoid laryngectomy (SCL) and bilateral posterolateral neck dissection (PLND). Both patients received radiotherapy (RT) and their 1-year follow-up showed no evidence of recurrence or metastasis. The diagnostic and therapeutic aspects of these cases are discussed.     

Transoral CO<Subscript>2</Subscript> laser management for selected supraglottic tumors and neck dissection

This study aimed to evaluate transoral laser resection as a method of choice for conservation surgery for supraglottic laryngeal carcinoma in carefully selected patients. Between 1987 and 2006, 55 patients with early supraglottic carcinoma were selected for transoral laser surgery. The outcome of the endoscopic CO₂ laser resection and larynx-sparing functional results without tracheotomy was evaluated. Fifty-five patients with T1, T2 supraglottic carcinomas underwent transoral CO₂ laser resection and seven patients with manifest neck metastasis required a neck dissection at one session with additional postoperative radiation therapy. There was no need for tracheotomy; deglutition was moderately disturbed. Forty of the 55 (73%) patients had no signs of recurrence to date. Fifteen patients with local recurrences underwent salvage therapies: six repeated laser excisions, three radiotherapies, four supraglottic laryngectomies and two total laryngectomies. Laser-specific survival is 84% and larynx preservation is 96%. The overall 5-year-survival after salvage treatment is 98%. Development of late metastasis required five radical neck dissections (RND) and radiation therapy. The results indicated that transoral laser resection can control early supraglottic cancer in selected patients and can be combined with simultaneous neck dissection with less morbidity than “open surgery”.     

声门下癌的临床及其手术治疗

目的 探讨声门下癌的临床特点、手术和重建喉功能的方法及喉声门下部分切除术的可行性。方法 总结 １９８１￣１９９７年声门下癌１３例,Ｔ１－２Ｎｏ６例,Ｔ３Ｎｏ１例,Ｔ３－４Ｎ１－２６例。４例行全喉切除术,９例行喉声门下部分切除术和扩大喉声门下部分切除术（累及气管者）,分别以单侧或双侧皮瓣、肌筋膜瓣整复,喉腔内置“Ｔ”型硅胶管扩张,２￣６个月拨除。其中６例行颈清扫术。结果 除４例全喉切除术者外,余９例     

两种颈淋结巴清扫术对口腔鳞癌cN0期患者手术疗效比较：基于国内样本的Meta分析

目的:采用Meta分析方法，综合定量分析国内公开发表的有关国人cN0期口腔鳞癌患者行两种颈淋巴结清扫术的疗效，为cN0期患者颈淋巴结手术处理方式提供参考依据。方法：搜集国内所有公开发表的、随访资料完整、随机性良好的、分别采用肩胛舌骨上颈淋巴结清扫术(supraomohyoid neck dissection, SOND)与根治性颈淋结巴清扫术（radical neck dissection, RND）对cN0期患者手术疗效行对比观察的相关研究。对符合条件的资料行Meta分析，计算两组间淋巴结转移复发的比数比（odds ratio, OR）。结果：在88篇报道中，有6篇符合纳入标准。标本量1?065例，其中SOND组291例，阳性97例；RND组774例，阳性236例。OR=0.87<0.05（SOND/RND），95%CI为（0.60, 1.26）。两者差异无统计学意义。结论：SOND与RND对cN0期口腔鳞癌患者的手术疗效无明显差异，SOND可取代RND以提高患者生存质量。