Prevalence of submandibular gland involvement in neck dissection specimens of patients with oral cavity carcinoma

IntroductionThe submandibular gland is commonly removed during neck dissection in patients with head and neck cancer. The patient experiences various complications due to the removal of the submandibular gland. Therefore, the necessity of submandibular gland removal should be evaluated. This study aimed to was to determine the frequency of submandibular gland (SMG) involvement in patients with oral cavity squamous cell carcinoma (SCC).MethodsIn this retrospective study, medical records of patients with oral cavity cancer who were referred to Amir Alam Hospital between 2015 and 2020 were reviewed. Patient data includes surgical report, histopathology report (tumor size, number of lymph nodes involved, and SMG tumor involvement), Tumor Location, History of Smoking, History of Opium, and Alcohol consumption was extracted from patients' medical records and statistically analyzed using SPSS software version 20.ResultsOf the total 60 patients, 24 (40%) were female and 36 (60%) were male. Smoking was reported in 55% of patients with a mean of 4.11 pack-year. Alcohol and opium use was observed in 18.3% and 26% of patients. The majority of patients (78.3%) had tongue cancer. More than half of the patients (53.3%) reported tumors of 2 cm or smaller, and 16.7% of patients had tumors larger than 4 cm. The majority of patients (80.3%) did not have cervical lymph node metastasis, 13.1% had 1–2 involved lymph nodes and 4.9% had 3 to 6 involved lymph nodes and there were no cases of metastasis to more than 6 lymph nodes. Finally, no individual had submandibular gland involvement, ie 100% of patients had no submandibular gland metastasis.ConclusionThe results confirmed that SMG involvement is very rare in patients with oral SCC and therefore it is not necessary to remove the gland as part of treatment. Preservation of the submandibular gland prevents complications related to the removal of this gland and reduces morbidity and increases the quality of life of patients after surgery.     

Elective neck dissection and survival in patients with squamous cell carcinoma of the oral cavity and oropharynx

OBJECTIVE/HYPOTHESIS: The utility of elective neck dissection in the management of patients with oral cavity and oropharyngeal cancer who present without neck metastases remains controversial. The study addressed the question of whether elective neck dissection improves regional control and survival in patients with squamous cell carcinoma of the oral cavity and oropharynx presenting with T1/T2 node-negative disease. STUDY DESIGN: A nonrandomized, uncontrolled retrospective chart review. METHODS: A nonrandomized, uncontrolled retrospective chart review was performed. Resection of the primary tumor was performed in all patients. The neck was observed in one group, and elective neck dissection was performed for patients in another group. RESULTS: The study data indicated that elective neck dissection significantly improves regional control and regional recurrence-free survival. Elective neck dissection when compared with observation of the neck did not improve overall survival. CONCLUSION: Elective neck dissection reduces regional recurrence and may extend disease-free survival.     

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。     

Preserving level IIb lymph nodes in elective supraomohyoid neck dissection for oral cavity squamous cell carcinoma

OBJECTIVE: To determine whether level IIb lymph nodes can be saved in elective supraomohyoid neck dissection (SOHND) as a treatment for patients with squamous cell carcinoma of the oral cavity. DESIGN: Prospective analysis of a case series. SETTING: University hospital. PATIENTS AND INTERVENTIONS: From 1997 to 2001, 74 patients with squamous cell carcinoma of the oral cavity and with no palpable lymph nodes at the neck who underwent an elective SOHND were prospectively studied. MAIN OUTCOME MEASURES: The incidence of pathological metastasis to level IIb lymph nodes and the regional recurrence within this area after elective SOHND was performed were evaluated. RESULTS: Of the 74 patients, 24 (32%) had lymph nodes positive for microscopic metastatic squamous cell carcinoma. Four (5%) of the 74 patients had involvement of level IIb lymph nodes. There was no instance of isolated metastasis to level IIb lymph nodes without involvement of other nodes in the SOHND specimens. There were 6 cases of the ipsilateral neck recurrences, and of these, 2 patients (3% of all patients) developed recurrences in the level II lymph nodes. CONCLUSIONS: Level IIb lymph node metastasis was rare in this study, and nodal recurrence in this area after SOHND in squamous cell carcinoma of the oral cavity was infrequent. Therefore, this region may be preserved in elective SOHND in patients with squamous cell carcinoma of the oral cavity.     

Selective vs modified radical neck dissection and postoperative radiotherapy vs observation in the treatment of squamous cell carcinoma of the oral tongue

OBJECTIVES: To assess the role of selective neck dissection in patients with squamous cell carcinoma (SCC) of the oral tongue with advanced nodal disease, and to assess the role of postoperative radiotherapy in patients with SCC of the oral tongue with pathologically N1 necks. DESIGN: Retrospective study of the medical records of all patients who underwent neck dissection for SCC of the oral tongue from January 1, 1980, to December 31, 1995. Median follow-up was 5.7 years. SETTING: The University of Texas M. D. Anderson Cancer Center, Houston, a tertiary care cancer hospital. PATIENTS: A total of 220 patients with SCC of the oral tongue who received surgical treatment of both the primary tumor and the neck and who had an identifiable type of neck dissection, no synchronous or metachronous lesions, and no evidence of local recurrence. INTERVENTIONS: All patients underwent resection of the primary tumor and neck dissection. The extent of neck dissection was determined by surgeon preference. Some patients received radiotherapy to the neck as well. MAIN OUTCOME MEASURES: Clinical and pathological nodal status, type of neck dissection, and use of radiotherapy. The end points evaluated included the regional control rates. RESULTS: For clinically N+ patients, 5 of 45 treated with selective neck dissection and 1 of 19 treated with radical or modified radical neck dissection had recurrences in the ipsilateral neck. If only patients with significant tumor burden on final pathological examination (clinically N+/pathologically N2) are considered, 4 (25.0%) of 16 patients undergoing selective neck dissection had recurrences in the neck, while none of the 14 patients treated with radical or modified radical neck dissection had recurrences in the ipsilateral neck (P = .07). Of the 50 patients who had pathologically N1 disease, 25 received postoperative radiotherapy and 25 did not. Of the latter, 2 had recurrences in the neck, while none of the 25 patients who received radiotherapy had recurrences in the neck (P = .24). CONCLUSIONS: Selective neck dissection may be sufficient for many N+ patients with SCC of the oral tongue, but some patients with extensive nodal disease may benefit from more aggressive treatment of the neck. Radiotherapy may be beneficial for all of the node-positive patients, but further studies are needed. Prospective, randomized clinical trials will be useful in further defining the role of selective neck dissection in the clinically N2 neck and radiotherapy in the N1 neck for patients with SCC of the oral tongue.     

Transoral laser resection with staged discontinuous neck dissection for oral cavity and oropharynx squamous cell carcinoma

Transoral laser resection of oral cavity and oropharynx squamous cell carcinoma (OOSCC) is a widely accepted approach in the absence of cervical lymph node metastases. This study investigated the results of transoral laser surgery and discontinuous neck dissection (ND) for OOSCC with clinically obvious or suspected cervical node metastases. One hundred seventeen patients with infiltrating oral carcinoma were treated for cure with transoral resection of the primary and staged ND. Twenty-nine primaries were classified as T1, 50 as T2, 35 as T3, and 3 as T4. Lymph node metastases were identified in the ND specimen of 36 patients. All patients were followed for a minimum of 3 years unless they died. Estimated tumor-related survival after 5 years is 81% for stage I and II disease of the oral cavity, 86% for stage I and II disease of the oropharynx, 73% for stage III disease of the oral cavity, 65% for stage III disease of the oropharynx, and 21% for stage IV disease of the oral cavity and the oropharynx. Local and regional control of cancer was achieved in 72 (62%) of the 117 patients. Forty-five local and regional recurrences were diagnosed during the follow-up period. Two patients died of distant metastases with no evidence of local or regional recurrence. The combination of transoral laser resection and staged ND for the treatment of OOSCC seems to offer satisfactory cure rates for a selected group of patients. These two minor surgical interventions cause less morbidity than commando-type surgery and lead to low perioperative mortality and morbidity.     

Prevalence and localization of nodal metastases in squamous cell carcinoma of the oral cavity: role and extension of neck dissection

Lymph node (LN) metastases represent the most important negative prognostic factor in squamous cell carcinoma (SCC) of the oral cavity, even though controversies still exist regarding their management. The aim of this study was to retrospectively analyze our experience in surgical management of SCC of the oral cavity with particular focus on the prevalence and localization of lymph nodal metastases and recurrences. The clinical records of 89 consecutive patients treated from 1983 to 2002 by concomitant surgery on both the T and N sites, excluding those undergoing salvage surgery, were reviewed. A total of 119 neck dissections (ND) were performed. Survival outcomes were calculated by the Kaplan–Meier method, while univariate comparisons by the log-rank and non-parametric tests were performed between different groups of patients. Five-year overall and determinate survivals were 50 and 57%, respectively. LN metastases were observed in 52% (56% of these showing extracapsular spread) and their presence strongly correlated with determinate survival (p < 0.0001). The prevalence of clinical and occult nodal disease was not related to the pT status. Neck levels II (59%) and I (56%) were most frequently involved. Metastases to level IV accounted for 15% of positive LN, even though 28% of them turned out to be skip metastases. Five neck recurrences were observed, only one of which was salvaged by surgery. The high prevalence of clinical and occult LN metastases in this setting suggests that ND should be performed on a nearly routine basis, even for lesions with a low-T category and a cN0 neck. Moreover, ND should always encompass level IV due to the possibility of skip metastases, particularly in tumors involving the oral tongue. In patients with a cN+ neck, levels from I to V should be addressed, particularly in the presence of metastases at levels III and IV.     

Value of the supraomohyoid neck dissection with frozen section analysis as a staging procedure in the clinically negative neck in squamous cell carcinoma of the oral cavity

Summary A retrospective analysis was performed to evaluate with the efficacy of elective supraomohyoid neck dissection (SOND) with frozen section (FS) analysis in 57 newly diagnosed patients (62 SONDs) with squamous cell carinoma of the oral cavity. The protocol included sampling of both the most suspect and largest node in the jugulodigastric region (if present) and the most distal jugulo-omohyoid lymph node (if present). These nodes were then studied with FS histological examination. In the absence of evident nodes for FS analysis during surgery, histological examination uncovered occult metastatic disease in 3 of 11 SOND specimens. Among the remaining patients FS analysis revealed occult metastatic disease in 10 of the 51 samples (19.6%). In these latter cases surgery was continued using standard or modified radical neck dissection en bloc with the primary tumor. In 1 specimen only a single metastasis was found outside the original extent of the SOND. Among 41 FS analysis reports stating the absence of metastatic disease, histological examination of the SOND specimens demonstrated occult nodal disease in 7 (17%). All of the cervical metastases appeared in the ipsilateral side of the neck. False FS reports did not occur. In the histologically proven absence of metastatic disease in the SOND specimens, disease recurrence in the neck occurred only in 3 cases (7%), all in the presence of local failure: once in the previous SOND area, once in the ipsilateral supraclavicular region and once on the contralateral side. The results of our analyses support the conclusion that elective SOND with FS can be a valid staging procedure and a valuable approach to the management of the clinically negative neck in patients with squamous cell carcinoma of the oral cavity. Offprint requests to: J. J. Manni     

肩胛舌骨肌上颈清扫术在临床N0口腔癌治疗中的应用

目的探讨肩胛舌骨肌上颈清扫术在口腔癌治疗中的应用价值。方法对27例临床N0(T1~3)口腔鳞状细胞癌患者行肩胛舌骨肌上颈清扫,清扫范围为第Ⅰ、Ⅱ、Ⅲ区淋巴结。记录颈清扫手术时间、术后淋巴结病理检查结果、术后肩功能及随访结果。结果手术时间平均(x±s)为(16±02)h。术后病理检查证实5例出现颈淋巴转移(19%),转移发生于第Ⅰ区2例(7%)、第Ⅱ区4例(15%),其中1例同时存在第Ⅰ、Ⅱ区转移。肩功能在术后3个月内基本恢复。术后随访2~4年,随访率100%,未见原发灶复发及颈淋巴转移。结论肩胛舌骨肌上颈清扫术是临床颈部N0口腔癌的合适术式,它既能达到治疗目的,又能最大程度地保留肩颈部外形与功能。     

Level IIb lymph nodes metastasis in elective supraomohyoid neck dissection for oral cavity squamous cell carcinoma: a molecular-based study

OBJECTIVES: To identify the incidence of level IIb lymph nodes metastasis in elective supraomohyoid neck dissection (SOHND) as a treatment for patients with squamous cell carcinoma (SCC) of the oral cavity. STUDY DESIGN: Prospective analysis of a case series. METHODS: Forty-eight patients with SCC of the oral cavity and with no palpable lymph nodes at the neck who underwent an elective SOHND were prospectively studied. The incidence of micrometastasis to level IIb lymph nodes after performing elective SOHND was evaluated by pathologic examination and molecular analysis. RESULTS: Of the 48 patients, 15 (31%) by pathologic analysis and 22 (46%) by molecular analysis had lymph nodes positive for metastatic SCC. By molecular analysis, 5 (10%) of the 48 patients had involvement of level IIb lymph nodes. All patients with metastasis to level IIb lymph nodes have their primary lesions in the tongue and constituted 22% of patients with tongue lesions. There was no instance of isolated metastasis to level IIb lymph nodes without involvement of other nodes in the SOHND specimens. CONCLUSIONS: In this study, level IIb lymph node metastasis was only found in association with tongue carcinoma. Although this region may be preserved in elective SOHND in patients with SCC of the oral cavity, it should be included whenever the tongue is the primary site.     

Management of the neck in N0 squamous cell carcinoma of the oral cavity.

Mortality in treated squamous cell carcinoma of the oral cavity is most often owing to locoregional failure. In an attempt to improve survival, an aggressive approach to surgical management is often favoured. Although it is generally accepted that the N0 neck should be treated if the risk of micrometastatic disease exceeds 20%, there is little direct support in the literature for this position. A retrospective review of all patients presenting with T1-2, N0 squamous cell carcinoma of the oral cavity treated at the Cancer Control Agency of British Columbia from 1985 to 1994 was conducted. Patients were followed for a minimum of 5 years with documentation of patterns of recurrence and disease-specific survival relative to initial management. The decision regarding management of the neck was frequently made to accommodate treatment of the primary site or reconstructive strategies. Thirteen percent of patients with T1, N0 disease underwent prophylactic neck dissection. No significant difference in outcome was noted in this group. Thirty-three percent of patients with T2, N0 disease underwent prophylactic neck dissection. There was a trend toward improved 5-year survival and lower recurrence rates in the group whose necks were treated, but the difference was not found to be statistically significant. In conclusion, this review showed a trend toward increased survival with prophylactic treatment of the neck in T2, N0 squamous cell carcinoma of the oral cavity, but a larger study would be needed to show a statistically significant benefit.     

Management of the clinically negative neck in early squamous cell carcinoma of the oral cavity

The management of the clinically negative neck in early squamous cell carcinoma of the oral cavity is controversial. This article presents the arguments in favor and against the various options for management of these patients.     

Research on neck dissection for oral squamous-cell carcinoma:a bibliometric analysis

INTRODUCTION As one of the most common oral malignancies, oral squamous-cell carcinoma (OSCC) accounts for ～4％ of all malignant tumours in the body, with over 3...     

Verrucous carcinoma of the oral cavity

The clinical course and morphologic (light and ultrastructural) characteristics of a case of verrucous carcinoma of the lower gingival mucosa are presented. Clinical course of the patient was unfavorable following surgery (supposedly incomplete) and radiotherapy (6,000 R) of the tumor. The therapeutic factors that may influence an unfavourable prognosis are commented upon, especially in regard to a slow-growing neoplasm with a generally good course.