Extent of neck dissection for patients with clinical N1 oral cancer
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ORIGINAL ARTICLE
Extent of neck dissection for patients with clinical N1 oral cancer Yasumasa Kakei1 · Hirokazu Komatsu2 · Tsutomu Minamikawa1 · Takumi Hasegawa1 · Masanori Teshima2 · Hirotaka Shinomiya2 · Naoki Otsuki2 · Ken‑ichi Nibu2 · Masaya Akashi1 Received: 9 October 2019 / Accepted: 12 February 2020 © The Author(s) 2020
Abstract Background No clear consensus has been reached on the indication of supraomohyoid neck dissection (SOHND) for clinically positive lymph-node metastasis. Patients Consecutive 100 patients with previously untreated oral cancer treated at Kobe University Hospital were included in this study. All patients were clinically staged as anyTN1M0 and underwent radical dissection of the primary site and level I–V neck dissection as the initial treatment. Results None of the 100 patients had pathological lymph-node metastasis (pLN) to level V. pLN to level IV was observed in two patients with tongue cancer in whom clinical lymph-node metastasis was preoperatively observed at level II. Conclusions Level V may be excluded in the neck dissection for patients with N1 oral cancers. Level IV dissection should be considered in the patient with tongue cancer and clinical lymph-node metastasis at level II. Keywords Tongue cancer · Clinical N1 · Neck dissection · Level IV · Level V · Supraomohyoid neck dissection · N1 · Oral cancer
Introduction Supraomohyoid neck dissection (SOHND) is classified as a selective dissection of levels I, II, and III of the neck [1]. Since skip metastasis to level IV is rare in oral cancer [2] and recent advances in diagnostic imaging including enhanced computed tomography (CT), magnetic resonance imaging (MRI), as well as positron emission tomography/ computed tomography (PET-CT) have provided precise preoperative evaluation of neck lymph-node metastases, a prospective trial on prophylactic neck dissections in oral cancer was conducted and found no significant difference in survival between modified radical neck dissection (MRND) and SOHND groups [3]. Now, SOHND has been accepted worldwide as a technique of prophylactic neck dissection Yasumasa Kakei and Hirokazu Komatsu have contributed equally to this article.
for high-risk clinical N0 (cN0) tongue/oral cancers [4, 5]. Furthermore, sentinel node biopsy (SNB) has been gradually accepted as a reliable staging test for patients with early disease and radiologically N0 neck. Since SNB can detect occult metastases with a sensitivity of 86–94%, patients with no sign of metastases on SNB could avoid neck dissection [6]. On the other hand, no clear consensus has been reached on the clinical N1 (cN1) cases, although several studies recommended SOHND even for clinical N1 (cN1) cases in recent reports [7, 8]. To explore the optimal surgical procedure for cN1 oral cancers, in this study, we investigated the appropriateness of SOHND in patients with cN1 oral cancer through a retrospective review of pathological neck lymphnode metastases (pLN) among the patients who underwent level I–V neck dissection for the treatment of cN1 o
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