Factors influencing contralateral lymph node metastasis from oral carcinoma

Abstract

Abstract:Background. An ipsilateral neck dissection is mandatory during initial treatment stages II-IV oral carcinomas. However, no consensus exists whether or not to perform an elective contralateral neck dissection.Methods. Five hundred thirteen consecutive cases of squamous cell carcinoma (269 tongue, 135 floor of the mouth, 44 inferior gingiva, 65 retromolar trigone) were reviewed. Tumor stages were: 69 T1, 227 T2, 217 T3-T4, 263 N0, 250 N1-N3. A total of 563 neck dissections were performed in 448 patients. Univariate and multivariate analysis of risk factors were performed using logistic regression.Results. Two hundred twenty-three patients (49.8%) had positive nodes in the specimen (182 ipsilateral, 36 bilateral, 5 contralateral). Contralateral neck recurrences occurred in 38 cases (33 not submitted to a contralateral neck dissection initially). Multivariate logistic regression analysis demonstrated that clinical stage (p = .0001), tumor crossing midline (p = .0011), and floor of the mouth involvement (p = .0236) were the most important predictors of contralateral metastasis.Conclusion. The contralateral side of the neck is a common and potentially preventable site of recurrence in tumors of the oral cavity. The multivariate model obtained discriminates patients with low and high risk (more than 20%) of contralateral metastasis. The application of this mathematical model can be useful for the indication of contralateral neck dissections, because not all tumors crossing midline are associated to a high risk (stages I and II tumors not involving the floor of the mouth) and not all tumors not crossing midline are at low risk (stages III and IV tumors involving the floor of the mouth).

Management of Gingivobuccal Complex Cancer

“…27 Nodal spread can occur to both sides of neck especially in lesions close to mid-line. 28 In patients with bilateral nodal metastasis, ab ilateral neck dissection with preservation of IJV on at least one side (the less affected side) is indicated. An alternative to this is to do as taged RND, the IJV resection is done on both the sides with an interval of 4weeks between them.…”

Topographic study on nerve-associated lymphatic vessels in the murine craniofacial region by immunohistochemistry and electron microscopy

“…Meanwhile, in aspect of clinical medicine, sentinel lymph node navigation surgery, being contrived from the viewpoint of lymphatic metastasis route, has been recently established as an operative cure for malignant tumors in the head and neck region (1,17). However, a number of cases involving skip and/or distant tumor metastases not via the sentinel lymph node in the head and neck cancer have been reported (3,13,26), and the metastatic pathway has not been analyzed. Thus, the precise organization of the lymphatic vessels in the craniofacial region should be defined for understanding functional significance of the lymphatic system and metastases of quently with peroxidase (PO) or alkaline phosphatase (AP)-conjugated goat anti-rabbit IgG (Histofine Simple Stain; Nichirei Bioscience, Tokyo).…”

Simultaneous Bilateral Neck Dissection

“…The status of the regional lymphatics is one of the most important prognostic indicators in patients with head and neck cancer 5,6,7,8 . Treatment of the neck in patients with clinical evidence of nodal metastasis has traditionally been surgical, that is systematic removal of all the lymphatic tissues called as radical neck dissection (RND) described by Crile and later popularized by Martin 9,10,11 .Dissemination of metastatic cancer to regional lymph nodes from primary sites in the upper aerodigestive tract occurs in a predictable and sequential fashion.…”