Selective Neck Dissection in Oral Cavity Cancer Is Not Without Morbidity
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ORIGINAL ARTICLE
Selective Neck Dissection in Oral Cavity Cancer Is Not Without Morbidity Adharsh Anand 1 & Sivakumar Vidhyadharan 1 & Narayana Subramaniam 1 & Deepak Balsubramanian 1 & Azhar Jan Battoo 1 & Subramania Iyer 1 & Krishnakumar Thankappan 1 Received: 15 April 2020 / Accepted: 25 August 2020 # Indian Association of Surgical Oncology 2020
Abstract The objective of this study is to analyze the morbidity of selective neck dissection (SND) in oral cavity squamous cell carcinoma (OCSCC). This is a cross-sectional study of 106 consecutive patients with T1 and T2 (AJCC seventh edition) stage cancers. Morbidity in terms of scar characteristics, cervical lymphedema, sensation, shoulder dysfunction, and smile asymmetry were analyzed. Scar outcomes were inferior in terms of poor complexion in 15 patients (14.2%), poor texture in 25 patients (23.6%), limited skin movement in 9 patients (8.5%), soft tissue deficit in 13 patients (12.3%), and lymphedema in 14 patients (13.2%). Smile asymmetry was seen in 29.2%. Shoulder dysfunction was seen in 7.5%. Patients who received adjuvant treatment had significant scar issues (p = 0.001), lymphedema (p < 0.001), and sensory issues (p = 0.003). SND in OCSCC is not without morbidity. Smile asymmetry was the commonest problem. Patients who got adjuvant treatment had significantly more morbidity. Keywords Selective neck dissection . Oral cancer . Morbidity . Sentinel node biopsy . Shoulder dysfunction
Introduction Oral cavity squamous cell carcinoma (OCSCC) has a high propensity to spread to the neck. Occult metastasis to cervical lymph nodes in OCSCC ranges from 30 to 40% [1]. Surgery is the usually the preferred modality of treatment and the adjuvant therapy in the form of radiotherapy (RT) or chemoradiotherapy (CRT) is reserved for adverse pathological features or high-stage disease [2]. Surgery involves a wide resection of the primary lesion and neck dissection. Neck dissection is usually an elective selective neck dissection in a clinically negative neck, where only the primary echelon nodes [3] are addressed or a therapeutic neck dissection in a clinically positive neck. Though a comprehensive neck dissection is preferred in a node-positive neck, there are also reports favoring a selective neck dissection in such patients [4, 5]. Most of the previous studies have concluded that selective neck dissection (SND) is a safe and less morbid procedure [6, 7]. The
* Krishnakumar Thankappan [email protected] 1
Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, AIMS Ponekkara PO, Kochi, Kerala, India
comparison in many of these studies are with other more invasive procedures such as modified radical neck dissection or radical neck dissection. SND is a less morbid procedure [8]. But, it is not without morbidity. This is important in the background of studies on sentinel node biopsy (SNB) and remote access approaches [9]. The hypothesis of the present study was that SND has its own morbidity profile. The pu
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