“IIb or not IIb” – The necessity of dissection in patients with oral squamous cell carcinoma

Bartella, Alexander K.; Kloss‐Brandstätter, Anita; Kamal, Mohammad Amjad; Teichmann, Jan; Modabber, Ali; Hölzle, Frank; Lethaus, Bernd

doi:10.1016/j.jcms.2016.08.003

Cited by 11 publications

(19 citation statements)

References 22 publications

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“…Paleri et al found that only 18 of 903 patients with head and neck cancer (2%) had level 2b nodal disease. Several others have corroborated these data . Thus, there is evidence to suggest when level 2b could be safely omitted in SND.…”

Section: Discussionmentioning

confidence: 65%

“…Some claim that level 2b dissection is difficult and time‐consuming . Level 2b dissection required 3 additional minutes of surgical time in this study.…”

Section: Discussionmentioning

confidence: 73%

“…Some claim that level 2b dissection is difficult and time-consuming. 8,38,39 Level 2b dissection required 3 additional minutes of surgical time in this study. Although this was statistically significant, it was certainly not a clinically meaningful difference.…”

Section: Discussionmentioning

confidence: 99%

“…Several others have corroborated these data. 39 Thus, there is evidence to suggest when level 2b could be safely omitted in SND. However, this study was not designed or powered to answer this question.…”

Section: Discussionmentioning

confidence: 99%

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2b or not 2b? Shoulder function after level 2b neck dissection: A double‐blind randomized controlled clinical trial

Dziegielewski

McNeely

Ashworth

et al. 2019

Cancer

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Background Selective neck dissection (SND) is a mainstay of head and neck cancer treatment. A common sequela is shoulder syndrome from spinal accessory nerve (SAN) trauma. Extensive dissection in neck levels 2 and 5 leads to SAN dysfunction. However, it is not known whether limited level 2 dissection reduces SAN injury. The purpose of this double‐blind randomized controlled trial was to determine whether omitting level 2b dissection would improve shoulder‐related quality of life and function. Methods Patients with head and neck cancers undergoing surgery were randomized 1:1 to SND without level 2b dissection (group 1) or with it (group 2) on their dominant‐hand side. Patients, caregivers, and assessors were blinded. The primary outcome was the change in the Neck Dissection Impairment Index (NDII) score after 6 months. An a priori calculation of the minimally important clinical difference in the NDII score was determined to establish a sample size of 15 patients per group (power = 0.8). Secondary outcomes included shoulder strength and range of motion (ROM) and SAN nerve conduction. The trial was registered at ClinicalTrials.gov (NCT00765791). Results Forty patients were enrolled, and 30 were included (15 per group). Six months after the surgery, group 2 demonstrated a significant median decrease in the NDII from the baseline (30 points) and in comparison with group 1, whose NDII dropped 17.5 points (P = .02). Shoulder ROM and SAN conduction demonstrated significant declines in group 2 (P ≤ .05). No adverse events occurred. Conclusions Level 2b should be omitted in SND when this is oncologically safe and feasible. This allows for an optimal balance between function and cancer cure.

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Section: Discussionmentioning

confidence: 65%

“…Some claim that level 2b dissection is difficult and time‐consuming . Level 2b dissection required 3 additional minutes of surgical time in this study.…”

Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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2b or not 2b? Shoulder function after level 2b neck dissection: A double‐blind randomized controlled clinical trial

Dziegielewski

McNeely

Ashworth

et al. 2019

Cancer

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“…It has been reported that the rate of IIb metastasis in early-stage oral cancer is extremely low at no more than 6% [5,[12][13][14][15][16][17]. Some clinicians therefore suggest that level IIb be exempted from neck dissection in early OSCC in order to improve HRQoL [5,8,17]. However, others disagree, and thus there is no consensus about the necessity of IIb dissection in T1-2N0M0 OSCC.…”

Section: Introductionmentioning

confidence: 99%

The necessity of IIb dissection in T1–T2N0M0 oral squamous cell carcinoma: protocol for a randomized controlled trial

Wang

Song

et al. 2019

Trials

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Background: There is a growing debate on the relationship between health-related quality of life (HRQoL) and patient survival which has been going on for the last few decades. The greatest wish of clinicians is to extend the latter while improving the former. Following neck dissection of early-stage oral carcinoma, "shoulder syndrome" appears due to traction of the accessory nerve during removal of level IIb, which greatly affects patient quality of life. Since occult metastasis in level IIb of early-stage oral carcinoma is extremely low, some surgeons suggest that level IIb can be exempt from dissection to improve the HRQoL. However, other surgeons take the opposite view, and thus there is no consensus on the necessity of IIb dissection in T1-2N0M0 oral squamous cell carcinoma (OSCC). Methods: We designed a parallel-group, randomized, non-inferiority trial that is supported by

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Oral Cavity Cancer Surgical and Nodal Management

Eskander,

Dziegielewski,

Patel

et al. 2024

JAMA Otolaryngol Head Neck Surg

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ImportanceLymph node metastases from oral cavity cancers are seen frequently, and there is still inconsistency, and occasional controversies, regarding the surgical management of the neck in patients with oral cancer. This review is intended to offer a surgically focused discussion of the current recommendations regarding management of the neck, focusing on the indications and extent of dissection required in patients with oral cavity squamous cell carcinoma while balancing surgical risk and oncologic outcome.ObservationsThe surgical management of the neck for oral cavity cancer has been robustly studied, as evidenced by substantial existing literature surrounding the topic. Prior published investigations have provided a sound foundation on which data-driven treatment algorithms can generally be recommended.ConclusionsExisting literature suggests that patients with oral cavity cancer should be fully staged preoperatively, and most patients should receive a neck dissection even when clinically N0. Quality standards supported by the literature include separation of each level during specimen handling and lymph node yield of 18 or more nodes. Sentinel lymph node biopsy can be considered in select tumors and within a well-trained multidisciplinary team.

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“IIb or not IIb” – The necessity of dissection in patients with oral squamous cell carcinoma

Cited by 11 publications

References 22 publications

2b or not 2b? Shoulder function after level 2b neck dissection: A double‐blind randomized controlled clinical trial

2b or not 2b? Shoulder function after level 2b neck dissection: A double‐blind randomized controlled clinical trial

The necessity of IIb dissection in T1–T2N0M0 oral squamous cell carcinoma: protocol for a randomized controlled trial

Oral Cavity Cancer Surgical and Nodal Management

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