Current Considerations in Neck Dissection

Ferlito, Alfio; Robbins, K. Thomas; Shaha, Ashok R.; Pellitteri, Phillip K.; Kowalski, Luiz Paulo; Gavilán, Javiér; Silver, Carl E.; Rinaldo, Alessandra; Medina, Jesús E.; Pitman, Karen T.; Byers, Robert M.

doi:10.1080/000164802753648259

Cited by 19 publications

(5 citation statements)

References 58 publications

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“…The quality of life after neck dissection is significantly improved if function is preserved. Morbidity can be prevented by selective neck dissection in selected cases 2, 3, 5, 6, 13–18. It has recently been reported that the probability of metastases in level 2b is very low 7–12…”

Section: Discussionmentioning

confidence: 99%

“…Efficacy of neck management is the most important prognostic factor in laryngeal cancer, as in all head and neck cancers 1, 2. Because of severe morbidities and unwanted results of radical neck dissection, which has been the mainstay of treatment for decades, selective and then super‐selective neck dissection procedures have been improved 2–6. It was shown that level 2b lymph node metastases are very rare in laryngeal cancers 7–12.…”

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confidence: 99%

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Accessory nerve function after level 2b–preserving selective neck dissection

et al. 2009

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Accessory nerve function after level 2b–preserving selective neck dissection

et al. 2009

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“…When the neck was preoperatively N0, a supra-omohyoid neck dissection was performed with frozen sections. If these nodes were positive at the frozen examination, the neck dissection was completed with the posterior triangle according to Ferlito and Medina 10 . All patients underwent surgical reconstruction of the resected structures with microvascular free flaps and donor sites as follows: 11 fibula (26.2%), 16 forearm (38.0%), 11 anterolateral thigh (26.2%), two iliac crest (4.8%), and two deep inferior epigastric perforator (4.8%).…”

Section: Methodsmentioning

confidence: 99%

Does Microvascular free flap Reconstruction in oral Squamous cell Carcinoma Improve Patient Survival?

Marchetti¹,

Pizzigallo²,

Cipriani³

et al. 2008

Otolaryngol.--head neck surg.

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“…Available reports on ECS in HNSCC demonstrate inconsistencies that limit their extrapolation to HPV‐related OPSCC. ECS is described as a negative prognosticator in studies that combine multiple subsites, including oral cavity, larynx, and hypopharynx 15‐19. The studies that do analyze oropharyngeal cancer fail to measure the impact of ECS stratified by HPV status 20‐22.…”

Section: Introductionmentioning

confidence: 99%

Extracapsular spread and adjuvant therapy in human papillomavirus‐related, p16‐positive oropharyngeal carcinoma

Sinha

Lewis

Piccirillo

et al. 2011

Cancer

230

244

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BACKGROUND: Extracapsular spread (ECS) is commonly used to justify adjuvant chemotherapy in patients with head and neck cancer. The role of ECS as a prognosticator and adjuvant therapy determinant in surgically resected, human papillomavirus-related oropharyngeal squamous cell carcinoma (OPSCC), however, has never been determined. METHODS: Of 210 oropharynx patients in a prospective transoral laser microsurgery database, 152 patients who had p16-positive primary OPSCC and pathologically positive necks were eligible for the study. ECS was measured from routine reporting (ECS report ) and by using a novel histologic grading system (ECS graded ). Proportional hazards models and matched analyses were used to compare the impact of ECS and adjuvant therapy on disease-free survival (DFS). Patients with and without graded ECS were matched for T-stage, surgical margins, and adjuvant therapy. RESULTS: At a median follow-up of 43 months, the presence of ECS was not associated with poorer DFS in multivariate analyses (ECS report : hazard ratio [HR], 3.42; 95% confidence interval [CI], 0.45-25.88; P ¼ .23; ECS graded : HR, 2.54; 95% CI, 0.88-7.34; P ¼ .09). T-stage and high-grade ECS, ie soft tissue metastasis (STM graded ) were prognostic. Overall and in the presence of ECS or even STM, adjuvant CRT was not associated with better DFS over radiotherapy alone (HR, 0.25; 95% CI, 0.06-1.13; P ¼ .07). In addition, matched analyses demonstrated no significant reduction in DFS for the presence of ECS versus the absence of ECS or reduced DFS for the administration of adjuvant radiotherapy alone versus CRT in ECS-positive patients. CONCLUSIONS: Routinely reported ECS was not prognostic in this study. Adjuvant CRT versus radiotherapy alone produced no improvement in DFS for ECS-positive patients. The authors propose that de-escalated adjuvant therapy should be considered for patients with p16-positive OPSCC who undergo surgery and that routinely reported ECS should not be used to justify adjuvant chemotherapy. Cancer 2012;118:3519-

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Current Considerations in Neck Dissection

Cited by 19 publications

References 58 publications

Accessory nerve function after level 2b–preserving selective neck dissection

Accessory nerve function after level 2b–preserving selective neck dissection

Does Microvascular free flap Reconstruction in oral Squamous cell Carcinoma Improve Patient Survival?

Extracapsular spread and adjuvant therapy in human papillomavirus‐related, p16‐positive oropharyngeal carcinoma

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