Management of the neck in oral cancers

Pantvaidya, Gouri; Rao, Karthik Nagaraja; D’Cruz, Anil

doi:10.1016/j.oraloncology.2019.104476

Cited by 29 publications

(15 citation statements)

References 61 publications

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“…Based on the model, level IIa metastasis and LVP were predictors of level IIb metastasis. A majority of studies concur that positive nodes at level IIa predict level IIb metastases 9 , 30 . However, to the best of our knowledge, this is the first report of an independent association between LVP and level IIb metastasis in an OSCC patient cohort.…”

Section: Discussionmentioning

confidence: 87%

“…Some authors have accordingly proposed that communications between cervical nerves and spinal accessory are responsible for remaining trapezius muscle motor function even after radical neck dissection 57 . Lastly, treatment modalities of OSCC, especially in managing the neck, are primarily based on TNM staging 9 . Our common recognition on oral malignancy is that increasing T stage has a close to linear correlation with regional and distant metastasis.…”

Section: Discussionmentioning

confidence: 99%

“…Later, radical neck dissection was introduced, becoming the standard in managing oral cancer metastatic lymph node 8 . However, recognizing that morbidity was clearly associated with the increasing extent of neck dissections, surgeons consistently sought to decrease the extent to achieve a balance between oncologic safety and acceptable morbidity 9 . Due to their invasive nature, radical neck dissections are now performed only for patients with large metastatic nodes with extranodal extension into the non-lymphatic structures 10 .…”

Section: Introductionmentioning

confidence: 99%

“…There is also an overall consensus for performing selective neck dissections (SND) rather than modified radical neck dissections (MRND) for patients with clinical node-negative necks 12 . In spite of such gradual establishment of protocol for treating neck in OSCC patients, there is an ongoing debate concerning dissection of level IIB in both node-negative and positive patients, primarily due to the low incidence of metastasis in this region and possible injury to the spinal accessory nerve (SAN) 9 . Previous studies have argued for and against dissecting level IIB based on descriptive results regarding the level IIb lymph node metastasis rate 13 , 14 .…”

Section: Introductionmentioning

confidence: 99%

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Predictive modelling of level IIb lymph node metastasis in oral squamous cell carcinoma

Yang

Son

Lee

et al. 2021

Sci Rep

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The aim of the present study was to examine the conditions, characteristics, and risk factors of level IIb lymph node metastases in oral squamous cell carcinoma and to formulate surgical criteria for level IIb lymph node dissection. We analyzed clinical and pathological records for 541 oral squamous carcinoma patients in relation to level IIb metastasis. Univariate and multivariate analyses were performed to detect risk factors for level IIb lymph node metastasis; a predictive model was built based on multivariate analysis and tested in a validation group. Univariate and multivariate analyses using the training group indicated that level IIa metastasis and Lymphovascular permeation (LVP) were two independent risk factors for level IIb lymph node metastasis. This model was built and tested in a validation group, the area under the curve being 0.697 (P < .0.001). The model’s sensitivity was 66.7% and specificity was 77.4%. Nomogram incorporating validated variables was developed for level IIb metastasis prediction. Expected survival probabilites were analysed to specify significance of model's variable on patients’ overall survival and recurrence. Level IIb dissection should be performed in patients with level IIa metastasis and LVP. However, thorough consideration of the oncologic safety of omitting level IIb dissection is compulsory.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictive modelling of level IIb lymph node metastasis in oral squamous cell carcinoma

Yang

Son

Lee

et al. 2021

Sci Rep

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“…However, as nodal metastases to levels IV and V are rare in the absence of involvement of upper levels, an increasing number of studies have shown evidence for feasibility of SND even in some node-positive oral cancers [ 3 ]. The meta-analysis by Liang et al [ 4 ] showed no difference in regional recurrence, disease-specific survival, or overall survival for patients treated with CND or SND in patients with clinically node-positive (cN+) oral cancers.…”

Section: Introductionmentioning

confidence: 99%

Analysis of the Role of Selective Neck Dissection in Clinically Node-Positive T3/T4 Oral Cancers

Maharaj

Seenivasagam

Majumdar

et al. 2022

BioMed Research International

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Introduction. The concept of selective neck dissection (SND) in locally advanced oral cancers is emerging. Contemporary studies support the feasibility of SND in selected node-positive oral cancers with early primaries. Nevertheless, the suitability of SND in clinically node-positive (cN+) oral cancers with advanced primaries (T3/T4) is unknown. Aim. This study explores if patients with cN+ advanced primaries were suitable candidates for SND by spotting the involved lymph node distribution in various stations of the neck. Secondary objectives were to check if predictive clinicopathological factors for metastases to the neck in general also apply for lymph node metastases to levels IV and V. Methods. The present retrospective study analysed the distribution of pathologically involved lymph nodes in 134 patients and explored the interrelation of various predictive factors and cervical metastases overall and those specific to levels IV and V. Results. Level V was involved in 6.7% (6/83) of T4 and none of the T3 primaries. Depth of invasion (DOI), perineural invasion (PNI), and skin invasion were statistically significant predictors for nodal metastases in general on multivariate analysis. Conclusion. Our analysis supports the option of considering SND, sparing level V in patients with cN+ oral cancers in a subset with T3 primary and nodal stage N2 and below.

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Identification of occult metastatic disease via lymphoscintigraphy‐guided neck dissection in N0 oral squamous cell carcinoma

et al. 2022

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Background: The purpose of this study is to assess the efficacy of lymphoscintigraphy-guided neck dissection (LSG-ND) in the treatment of N0 oral squamous cell carcinoma.Methods: A retrospective cohort study of patients with N0 oral squamous cell carcinoma (SCC) who had either LSG-ND or neck dissection (ND) at our institution between 2008 and 2020. Results: Eighty-seven patients met criteria with N0 oral squamous cell carcinoma with no previous treatment or neck surgery (27 LSG-ND, 60 ND). Sentinel lymph nodes were identified on the contralateral side in 14.8% of patients with unilateral tumors in the LSG-ND group, with 22.2% of cases with unexpected lymphatic drainage outside ipsilateral levels I-III. No recurrences to date have occurred in the LSG-ND cohort, while 13.3% of patients with ND had regional recurrence (p = 0.04). Conclusions: LSG-ND provides a greater ability to identify occult metastatic disease with a significant reduction in regional recurrence in N0 oral SCC.

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Management of the neck in oral cancers

Cited by 29 publications

References 61 publications

Predictive modelling of level IIb lymph node metastasis in oral squamous cell carcinoma

Predictive modelling of level IIb lymph node metastasis in oral squamous cell carcinoma

Analysis of the Role of Selective Neck Dissection in Clinically Node-Positive T3/T4 Oral Cancers

Identification of occult metastatic disease via lymphoscintigraphy‐guided neck dissection in N0 oral squamous cell carcinoma

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