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Pagedar NA, Hoffman HT. Anatomic Variability of the Accessory Nerve: Implications for Dissection of Level IIB. Laryngoscope 2024; 134:154-159. [PMID: 37289066 PMCID: PMC10703995 DOI: 10.1002/lary.30758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVES During neck dissection, level IIB lymphadenectomy necessitates manipulation of the spinal accessory nerve that might be avoided and might cause postoperative disability. Current literature does not describe the effect of variation in the spinal accessory nerve in the upper neck. We sought to measure the effect of the dimensions of level IIB on nodal yield in level IIB and on patient reported neck symptoms. METHODS We measured the boundaries of level IIB of 150 patients undergoing neck dissection. Level II was dissected and separated into levels IIA and IIB intraoperatively. Patient-reported symptoms were assessed in 50 patients using the Neck Dissection Impairment Inventory. We computed descriptive statistics, and sought to identify correlation with the number and proportion of level IIB nodes and the number of metastatic nodes. Level IIB dimensions were analyzed as predictors of postoperative symptoms. RESULTS We measured 184 sides, with 37.7% of level II nodes found in level IIB. Mean accessory nerve length across level II was 2.5 cm. Every additional 1 cm in accessory nerve length was associated with two more level IIB nodes. At all accessory nerve lengths, meaningful numbers of nodes were present in level IIB. Accessory nerve length and other factors did not correlate with NDII scores. CONCLUSIONS Longer lengths of accessory nerve across level IIB correlated with greater nodal yield. However, data did not point to an accessory nerve length cutoff below which level IIB dissection could be avoided. In addition, the dimensions of level IIB did not correlate with postoperative neck symptoms. LEVEL OF EVIDENCE 2 Laryngoscope, 134:154-159, 2024.
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Affiliation(s)
- Nitin A Pagedar
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa, Iowa City, Iowa, U.S.A
| | - Henry T Hoffman
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa, Iowa City, Iowa, U.S.A
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Xu Y, He M, Liu Y, Wang Z, Yi J, Zhang Y. Delineation of neck node levels for patients with locally advanced supraglottic cancer receiving radical intensity-modulated radiotherapy: a cross-sectional study in Mainland China. Future Oncol 2022; 18:2475-2482. [PMID: 35703104 DOI: 10.2217/fon-2022-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: To survey the diversity of clinical target volumes (CTVs) for locally advanced supraglottic cancer (LA-SGC) with radical radiotherapy in mainland China. Methods: Radiation oncologists from 30 provinces and four representative cases (T2N1, T3N2b, T4N0, T4N2c) were included. Results: High risk (HR)-CTV included involved and the lower adjacent level was followed by most physicians (n = 160, 97.6%). In the N0-1 stage, whether contralateral levels II-III should be included in HR- or low risk (LR)-CTV was controversial. In the N2 stage, the bilateral levels II-IVb were included in LR-CTV (75-92.5% agreement). Levels Ib, V or VIb were included in CTV requiring certain conditions. Conclusion: Involved and lower adjacent levels were as HR-CTV. Whether bilateral levels II-IV are included in HR- or LR-CTV remain controversial.
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Affiliation(s)
- Yi Xu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Meilin He
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Yang Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Zekun Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Junlin Yi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China.,Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Hebei Cancer Hospital, Chinese Academy of Medical Sciences, Langfang, 065001, China
| | - Ye Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
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3
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Abstract
Since the first total laryngectomy was performed in the late 18th century, several improvements and variations in surgical techniques have been proposed for this procedure. The surgical techniques employed in total laryngectomy have not been comprehensively discussed to date. Thus, the main objective of this article was to address controversial aspects related to this procedure and compare different surgical techniques used for a total laryngectomy procedure from the beginning to the end. Although the management paradigms in laryngeal and hypopharyngeal squamous cell carcinomas have shifted to organ-preserving chemoradiotherapy protocols, total laryngectomy still plays a prominent role in the treatment of advanced and recurrent tumors. The increased incidence of complications associated with salvage total laryngectomy has driven efforts to improve the surgical techniques in various aspects of the operation. Loss of voice and impaired swallowing are the most difficult challenges to be overcome in laryngectomies, and the introduction of tracheoesophageal voice prostheses has made an enormous difference in postoperative rehabilitation and quality of life. Advancements in reconstruction techniques, tumor control, and metastatic management, such as prophylactic neck treatments and paratracheal nodal dissection (PTND), as well as the use of thyroid gland-preserving total laryngectomy in selected patients have all led to the increasing success of modern total laryngectomy. Several conclusions regarding the benchmarking of surgical techniques cannot be drawn. Issues regarding total laryngectomy are still open for discussion, and the technique will continue to require improvement in the near future.
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Affiliation(s)
- Adit Chotipanich
- Otolaryngology Department, Chonburi Cancer Hospital, Ministry of Public Health, Chonburi, THA
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4
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Rational surgical neck management in total laryngectomy for advanced stage laryngeal squamous cell carcinomas. J Cancer Res Clin Oncol 2020; 147:549-559. [PMID: 32809056 PMCID: PMC7817600 DOI: 10.1007/s00432-020-03352-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/04/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE Controversies exist in regard to surgical neck management in total laryngectomies (TL). International guidelines do not sufficiently discriminate neck sides and sublevels, or minimal neck-dissection nodal yield (NY). METHODS Thirty-seven consecutive primary TL cases from 2009 to 2019 were retrospectively analyzed in terms of local tumor growth using a previously established imaging scheme, metastatic neck involvement, and NY impact on survival. RESULTS There was no case of level IIB involvement on any side. For type A and B tumor midline involvement, no positive contralateral lymph nodes were found. Craniocaudal tumor extension correlated with contralateral neck involvement (OR: 1.098, p = 0.0493) and showed increased involvement when extending 33 mm (p = 0.0134). Using a bilateral NY of ≥ 24 for 5-year overall survival (OS) and ≥ 26 for 5-year disease-free survival (DFS) gave significantly increased rate advantages of 64 and 56%, respectively (both p < 0.0001). CONCLUSIONS This work sheds light on regional metastatic distribution pattern and its influence on TL cases. An NY of n ≥ 26 can be considered a desirable benchmark for bilateral selective neck dissections as it leads to improved OS and DFS. Therefore, an omission of distinct neck levels cannot be promoted at this time.
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Sanabria A, Shah JP, Medina JE, Olsen KD, Robbins KT, Silver CE, Rodrigo JP, Suárez C, Coca-Pelaz A, Shaha AR, Mäkitie AA, Rinaldo A, de Bree R, Strojan P, Hamoir M, Takes RP, Sjögren EV, Cannon T, Kowalski LP, Ferlito A. Incidence of Occult Lymph Node Metastasis in Primary Larynx Squamous Cell Carcinoma, by Subsite, T Classification and Neck Level: A Systematic Review. Cancers (Basel) 2020; 12:cancers12041059. [PMID: 32344717 PMCID: PMC7225965 DOI: 10.3390/cancers12041059] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Larynx cancer is a common site for tumors of the upper aerodigestive tract. In cases with a clinically negative neck, the indications for an elective neck treatment are still debated. The objective is to define the prevalence of occult metastasis based on the subsite of the primary tumor, T classification and neck node levels involved. Methods: All studies included provided the rate of occult metastases in cN0 larynx squamous cell carcinoma patients. The main outcome was the incidence of occult metastasis. The pooled incidence was calculated with random effects analysis. Results: 36 studies with 3803 patients fulfilled the criteria. The incidence of lymph node metastases for supraglottic and glottic tumors was 19.9% (95% CI 16.4–23.4) and 8.0% (95% CI 2.7–13.3), respectively. The incidence of occult metastasis for level I, level IV and level V was 2.4% (95% CI 0–6.1%), 2.0% (95% CI 0.9–3.1) and 0.4% (95% CI 0–1.0%), respectively. For all tumors, the incidence for sublevel IIB was 0.5% (95% CI 0–1.3). Conclusions: The incidence of occult lymph node metastasis is higher in supraglottic and T3–4 tumors. Level I and V and sublevel IIB should not be routinely included in the elective neck treatment of cN0 laryngeal cancer and, in addition, level IV should not be routinely included in cases of supraglottic tumors.
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Affiliation(s)
- Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Universitario San Vicente Fundación, Medellín 050010, Colombia;
- CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín 050021, Colombia
| | - Jatin P. Shah
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.P.S.); (A.R.S.)
| | - Jesus E. Medina
- Department of Otorhinolaryngology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA;
| | - Kerry D. Olsen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN 55902, USA;
| | - K. Thomas Robbins
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL 32952, USA;
| | - Carl E. Silver
- Department of Surgery, University of Arizona College of Medicine, Phoenix, AZ 85259, USA;
| | - Juan P. Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias-ISPA, 33011 Oviedo, Spain; (J.P.R.); (A.C.-P.)
- University of Oviedo-IUOPA, 33011 Oviedo, Spain
- Head and Neck Cancer Unit, CIBERONC, 28029 Madrid, Spain
| | - Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain;
| | - Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias-ISPA, 33011 Oviedo, Spain; (J.P.R.); (A.C.-P.)
- University of Oviedo-IUOPA, 33011 Oviedo, Spain
- Head and Neck Cancer Unit, CIBERONC, 28029 Madrid, Spain
| | - Ashok R. Shaha
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.P.S.); (A.R.S.)
| | - Antti A. Mäkitie
- Department of Otorhinolaryngology—Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, FI-00029 HUS Helsinki, Finland;
| | | | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, 3584CX Utrecht, The Netherlands;
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, SI-1000 Ljubljana, Slovenia;
| | - Marc Hamoir
- Department of Head and Neck Surgery, UC Louvain, St Luc University Hospital and King Albert II Cancer Institute, 1200 Brussels, Belgium;
| | - Robert P. Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands;
| | - Elisabeth V. Sjögren
- Department of Otolaryngology—Head and Neck Surgery, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands;
| | - Trinitia Cannon
- Department of Head and Neck Surgery and Communication Sciences, Duke University Health System, Durham, NC 27609, USA;
| | - Luiz P. Kowalski
- Department of Otorhinolaryngology-Head and Neck Surgery, A.C. Camargo Cancer Center, 01509-900 São Paulo, Brazil;
- Department of Head and Neck Surgery, University of São Paulo Medical School, 05402-000 São Paulo, Brazil
| | - Alfio Ferlito
- International Head and Neck Scientific Group, 35100 Padua, Italy
- Correspondence:
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Zhang B, Fu T, Zhang L. MicroRNA-153 suppresses human laryngeal squamous cell carcinoma migration and invasion by targeting the SNAI1 gene. Oncol Lett 2018; 16:5075-5083. [PMID: 30250575 PMCID: PMC6144539 DOI: 10.3892/ol.2018.9302] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 05/09/2018] [Indexed: 12/20/2022] Open
Abstract
Human laryngeal squamous cell carcinoma (LSCC) is a malignant cancer type. Epithelial-mesenchymal transition marker Snail family transcriptional repressor 1 (SNAI1) is associated with the occurrence, development, invasion and metastasis of numerous tumor types, such as lung, liver and ovarian cancer. Previous studies have indicated that microRNA-153 (miR-153) may serve as a novel tumor suppressor, which is involved in tumor metastasis; however, the role and clinical significance of miR-153 in LSCC are not fully understood. The aim of the present study was to determine the role of miR-153 in the growth and aggressiveness of LSCC cells. Bioinformatics prediction method, western blot analysis, Matrigel invasion assay and immunofluorescence were used to analyze whether SNAI1 can be regulated and controlled by miR-153 in LSCC cells. An inverse association between miR-153 and SNAI1 was observed in LSCC tissues. It was demonstrated that SNAI1 is a direct target of miR-153 in LSCC. In addition, the results indicated that miR-153 knockdown inhibited PCI-13 cell migration and invasion by targeting SNAI1, which may be a potential marker that can reflect the degree of malignancy in patients with LSCC. Furthermore, miR-153 knockdown decreased Twist family BHLH transcription factor 1 and metastasis-associated 1 family member 3 expression in LSCC cells. In conclusion, these data indicated that miR-153 regulates LSCC migration via the targeting of SNAI1 gene, which may be a potential predictor for patients with LSCC.
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Affiliation(s)
- Binbin Zhang
- Department of Otorhinolaryngology and Maxillofacial Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, P.R. China
| | - Tao Fu
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin 300060, P.R. China
| | - Lun Zhang
- Department of Otorhinolaryngology and Maxillofacial Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, P.R. China
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7
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Rivière D, Mancini J, Santini L, Giovanni A, Dessi P, Fakhry N. Lymph-node metastasis following total laryngectomy and total pharyngolaryngectomy for laryngeal and hypopharyngeal squamous cell carcinoma: Frequency, distribution and risk factors. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:163-166. [DOI: 10.1016/j.anorl.2017.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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8
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Frequency of bilateral cervical metastases in hypopharyngeal squamous cell carcinoma: a retrospective analysis of 203 cases after bilateral neck dissection. Eur Arch Otorhinolaryngol 2017; 274:3965-3970. [DOI: 10.1007/s00405-017-4724-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 08/19/2017] [Indexed: 12/28/2022]
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9
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Kanayama N, Nishiyama K, Kawaguchi Y, Konishi K, Ogawa K, Suzuki M, Yoshii T, Fujii T, Yoshino K, Teshima T. Selective neck irradiation for supraglottic cancer: focus on Sublevel IIb omission. Jpn J Clin Oncol 2015; 46:51-6. [PMID: 26491205 DOI: 10.1093/jjco/hyv156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 09/23/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To estimate selective neck irradiation omitting surgical Sublevel IIb. METHODS Bilateral necks of 47 patients (94 necks) were subjected to definitive radiotherapy for supraglottic cancer. Sixty-nine and 25 necks were clinically node negative (cN-) and clinically node positive (cN+), respectively. We subdivided Sublevel IIb by the international consensus guideline for radiotherapy into Sublevel IIb/a, directly posterior to the internal jugular vein, and Sublevel IIb/b, which was behind Sublevel IIb/a and coincided with surgical Sublevel IIb. Bilateral (Sub)levels IIa, III, IV and IIb/a were routinely irradiated, whereas Sublevel IIb/b was omitted from the elective clinical target volume in 73/94 treated necks (78%). RESULTS Two patients presented with ipsilateral Sublevel IIb/a metastases. No Sublevel IIb/b metastasis was observed. Five patients experienced cervical lymph node recurrence; Sublevel IIb/a recurrence developed in two patients, whereas no Sublevel IIb/b recurrence occurred even in the cN- necks of cN+ patients or cN0 patients. The 5-year regional control rates were 91.5% for Sublevel IIb/b-omitted patients and 77.8% for Sublevel IIb/b treated patients. CONCLUSIONS Selective neck irradiation omitting Sublevel IIb/b did not compromise regional control and could be indicated for cN- neck of supraglottic cancer.
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Affiliation(s)
- Naoyuki Kanayama
- Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka
| | - Kinji Nishiyama
- Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka Department of Radiation Oncology, Yao Municipal Hospital, Osaka
| | - Yoshifumi Kawaguchi
- Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka
| | - Koji Konishi
- Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka
| | - Kazuhiko Ogawa
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka
| | - Motoyuki Suzuki
- Department of Otolaryngology, Head and Neck Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Tadashi Yoshii
- Department of Otolaryngology, Head and Neck Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Takashi Fujii
- Department of Otolaryngology, Head and Neck Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Kunitoshi Yoshino
- Department of Otolaryngology, Head and Neck Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Teruki Teshima
- Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka
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Coskun HH, Medina JE, Robbins KT, Silver CE, Strojan P, Teymoortash A, Pellitteri PK, Rodrigo JP, Stoeckli SJ, Shaha AR, Suçrez C, Hartl DM, de Bree R, Takes RP, Hamoir M, Pitman KT, Rinaldo A, Ferlito A. Current philosophy in the surgical management of neck metastases for head and neck squamous cell carcinoma. Head Neck 2015; 37:915-26. [PMID: 24623715 PMCID: PMC4991629 DOI: 10.1002/hed.23689] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 01/03/2014] [Accepted: 03/08/2014] [Indexed: 12/11/2022] Open
Abstract
Neck dissection is an important treatment for metastases from upper aerodigestive carcinoma; an event that markedly reduces survival. Since its inception, the philosophy of the procedure has undergone significant change from one of radicalism to the current conservative approach. Furthermore, nonsurgical modalities have been introduced, and, in many situations, have supplanted neck surgery. The refinements of imaging the neck based on the concept of neck level involvement has encouraged new philosophies to evolve that seem to benefit patient outcomes particularly as this relates to diminished morbidity. The purpose of this review was to highlight the new paradigms for surgical removal of neck metastases using an evidence-based approach.
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Affiliation(s)
- H. Hakan Coskun
- Department of Otolaryngology–Head and Neck Surgery, Uludag University School of Medicine, Bursa, Turkey
| | - Jesus E. Medina
- Department of Otorhinolaryngology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - K. Thomas Robbins
- Division of Otolaryngology–Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Carl E. Silver
- Departments of Surgery and Otolaryngology–Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Afshin Teymoortash
- Department of Otolaryngology–Head and Neck Surgery, University of Marburg, Marburg, Germany
| | - Phillip K. Pellitteri
- Department of Otolaryngology–Head and Neck Surgery, Guthrie Health System, Sayre, Pennsylvania
| | - Juan P. Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto Universitario de Oncologıa del Principado de Asturias, Oviedo, Spain
| | - Sandro J. Stoeckli
- Department of Otorhinolaryngology–Head and Neck Surgery, Kantonsspital, St. Gallen, Switzerland
| | - Ashok R. Shaha
- Head and Neck Service, Memorial Sloan–Kettering Cancer Center, New York, New York
| | - Carlos Suçrez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto Universitario de Oncologıa del Principado de Asturias, Oviedo, Spain
| | - Dana M. Hartl
- Department of Otolaryngology–Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France
- Laboratoire de Phonétique et de Phonologie, Sorbonne Nouvelle, Paris, France
| | - Remco de Bree
- Department of Otolaryngology–Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Robert P. Takes
- Department of Otolaryngology–Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marc Hamoir
- Department of Head and Neck Surgery, Head and Neck Oncology Program, St Luc University Hospital and Cancer Center, Brussels, Belgium
| | - Karen T. Pitman
- Department of Surgery, Banner MD Anderson Cancer Center, Gilbert, Arizona
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