Neck Dissection for Cervical Lymph Node Metastases from Remote Primary Malignancies

Abstract

<jats:p>Background and Objectives: Patients with cervical lymph node metastases from remote primary tumours have poor prognoses because of the advanced stage of their cancer. Owing to recent progress in the nonsurgical management of various cancer types, options for surgical treatment to reduce tumour volume are increasing, and may help improve survival rates. For example, neck dissection may be a good option as a definitive therapy for some patients with resectable cervical metastases. We assessed patients who underwent neck dissection with curative intent and discuss the effectiveness of this approach for cervical metastases from remote malignancies. Material and Methods: We retrospectively reviewed the data of 18 patients (10 males and 8 females in an age range of 30–79 years) who underwent neck dissections for neck lymph node metastases from a remote primary tumour between 2010 and 2019. Patient clinical characteristics, preoperative accuracy of positive node localisation using fluorodeoxyglucose positron emission tomography–computed tomography (FDG/PET-CT), and patient survival rates were estimated. Results: Primary sites included ten lungs, two mammary glands, one thymus, one thoracic oesophagus, one stomach, one uterine cervix, one ovary, and one testis per patient. There were 19 levels with FDG/PET-CT positive nodes in 17 out of 18 patients. Conversely, there were 28 pathological positive levels out of 50 dissected levels. The sensitivity, specificity, positive and negative predictive values, and accuracy of FDG-PET/CT in predicting positive nodes were 69%, 88%, 95%, 47%, and 74%, respectively. The three-year overall survival (OS) rate for all patients was 70%. The three-year OS rate of the group with zero or one pathological positive nodes was 81%, which was significantly higher than that of the group with more than two positive nodes (51%) (p = 0.03). Conclusions: Neck dissection for cervical lymph node metastases from remote primary malignancies may improve prognoses, especially considering anticancer agents and radiotherapy advancements.</jats:p>

Optimal Extent of Neck Dissection for a Head and Neck Lymph Node Metastasis from a Remote Primary Site

“…This study aimed to explore the possibility of limiting the extent of ND by safely excluding certain neck levels in cases with cervical LN metastases originating from remote primary malignancies. As recent cutting-edge research has accumulated data, it is increasingly evident that surgically removing cervical LN metastasis from remote primary tumors can significantly reduce tumor burden and potentially improve survival rates [1,3,10]. This underscores the critical role of the surgical management of neck diseases as a diagnostic and therapeutic strategy for treating these patients.…”

“…In patients with resectable cervical metastases, ND may be a viable option as a definitive therapeutic approach in selective cases if other lesions, including those at the primary site, are well managed. The recent literature suggests that ND for cervical LN metastases from remote primary malignancies may improve both quality of life and survival [3].…”

“…However, in the context of cervical LN metastases from remote primary malignancies, the focus of this study, the infrequency of the cases and the heterogeneity of primary tumors have led to a paucity of data and less established optimal management [1,7]. Given this rarity, the standardization of ND procedures, particularly regarding the extent of dissection necessary for optimal patient outcomes, remains underexplored [3].…”

Development and validation of a diagnostic model for predicting cervical lymph node metastasis in laryngeal and hypopharyngeal carcinoma

“…The primary challenge encountered lies in accurately evaluating metastatic lymph nodes prior to treatment, particularly occult metastases. However, imaging may introduce concerns such as potential allergic reactions to contrast media and have limitations in the diagnosis of occult metastasis, the accuracy of fluorodeoxyglucose positron emission tomography–computed tomography(FDG-PET/CT) assessment is only 74%, and it carries risks such as radiation exposure and allergic reactions ( 8 , 9 ). Furthermore, while ultrasound contributes to some extent to the evaluation of cervical lymph node status, its accuracy is relatively modest, even when combined with invasive biopsies, with an overall accuracy of only 77.4% ( 10 ).…”

“…Furthermore, while ultrasound contributes to some extent to the evaluation of cervical lymph node status, its accuracy is relatively modest, even when combined with invasive biopsies, with an overall accuracy of only 77.4% ( 10 ). Preoperative biopsy also has limitations including low utilization rates, invasiveness, and the risk of biopsy failure ( 9 ). Accurate preoperative assessment of cervical lymph node status is critical, as incorrect assessments could impact subsequent patient care and treatment outcomes.…”