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Zhuge L, Wang S, Huang Z, Cai H, Li Z. The minimal number of examined lymph nodes for accurate nodal staging and favorable prognosis in T1-2 supraglottic laryngeal squamous cell carcinoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107041. [PMID: 37633174 DOI: 10.1016/j.ejso.2023.107041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/25/2023] [Accepted: 08/20/2023] [Indexed: 08/28/2023]
Abstract
OBJECTIVE The study aimed to investigate the minimal number of examined lymph nodes (ELNs) for accurate assessment of lymph node status and favorable prognosis in patients with stage T1-2 supraglottic laryngeal squamous cell carcinoma (LSCC) who received radical resection. METHODS Patients with stage T1-2 supraglottic LSCC from the Surveillance, Epidemiology, and End Results (SEER) database and the Chinese Academy of Medical Sciences, Cancer Hospital/National Cancer Center (NCC) were reviewed. The association of the ELN count with the identification of nodal metastasis and overall survival (OS) was analyzed using a multivariate regression model. Locally weighted scatterplot smoothing fitting curve and the 'changepoint' package were adopted to identify the optimal cut points using R. RESULTS A total of 429 patients from the SEER database and 53 patients from NCC were enrolled. The probability of identifying nodal metastasis was positively related to the ELN count. For patients diagnosed with pathological stage N0 (pN0) disease, the mortality risks rapidly decreased when the amount of ELNs exceeded ten, and those with ELNs >10 had better OS. CONCLUSION An adequate amount of ELNs benefits precise nodal staging in patients with stage T1-2 supraglottic LSCC. Ten lymph nodes are the minimum number of ELNs. For pN0 patients, an ELN count ≤10 is an unfavorable prognostic factor.
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Affiliation(s)
- Lingdun Zhuge
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shixu Wang
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zehao Huang
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huizhu Cai
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhengjiang Li
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Abstract
Although total laryngectomy continues to be important treatment of supraglottic laryngeal cancer, the management of early-stage disease has evolved from primary radiation/chemoradiation to consideration of partial laryngectomy surgery. Surgeon experience and careful patient selection can lead to excellent oncologic and functional outcomes for these techniques. However, advanced stage tumors and salvage situations are challenging and the ability to eradicate disease and preserve function should be carefully considered. Contraindications to supraglottic laryngectomy depend on surgical approach, as do complications. With adequate patient selection, high rates of cure and function can be achieved with both open and transoral supraglottic laryngectomy procedures.
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Affiliation(s)
- Rusha Patel
- Oklahoma University, 800 Stanton L Young Boulevard, Suite 1400, Oklahoma City, OK 73104, USA.
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Eltelety AM, Abou-Zeid MA, Abdelmalek ME, Nassar AA. Assessment of Occult Nodal Micrometastases to the Clinically Negative Contralateral Neck in Locally Advanced Supraglottic Squamous Cell Carcinoma. Indian J Otolaryngol Head Neck Surg 2022; 74:369-374. [PMID: 36213478 PMCID: PMC9535062 DOI: 10.1007/s12070-021-02806-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 08/08/2021] [Indexed: 10/20/2022] Open
Abstract
The aim of this study is to study the incidence of occult nodal micrometastases (ONM) in the contralateral neck and compare it to the laterality of the primary tumor. Retrospective analysis of the medical records of patients with locally advanced supraglottic squamous cell carcinoma and Clinically negative contralateral neck (cN0-CLN) - who had concurrent total laryngectomy and bilateral neck dissection as their primary treatment at the Otolaryngology Department, Al Kas Al Ainy School of Medicine-Cairo University between 2015 and 2020 - was conducted. Patients were divided into 3 groups according to the extent of the primary tumor. 28 patients met the inclusion criteria. Patients with well-lateralized tumors were 14 (Group A), tumors abutting the midline were 4 (Group B) and tumors significantly involving the contralateral side were 14 (Group C). There was no statistically significant difference in age of patients among the three groups. Eleven patients had cervical lymphadenopathy in the final pathology reports. Seven patients had ONM, all of whom were among group C patients (7/14; 50%). The degree of tumor differentiation was not associated with the presence of ONM. Treatment of the cN0-CLN is justified in locally advance supraglottic carcinoma significantly crossing the midline. The total number of patients with ONM in the cN0-CLN exceeds the threshold for observation, however the authors could not recommend or refute the practice of routine prophylactic treatment of the cN0-CLN as none of the patients-in this study-with well-lateralized tumors or tumors just abutting the midline showed ONM.
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Affiliation(s)
- Ahmad Mohamed Eltelety
- Otolaryngology Department, Al Kasr Al Ainy School of Medicine, Cairo University, Al Kasr Al Ainy, ElManial, Cairo, 11562 Egypt
| | - Mohamed Aly Abou-Zeid
- Otolaryngology Department, Al Kasr Al Ainy School of Medicine, Cairo University, Al Kasr Al Ainy, ElManial, Cairo, 11562 Egypt
| | - Mena Esmat Abdelmalek
- Otolaryngology Department, Al Kasr Al Ainy School of Medicine, Cairo University, Al Kasr Al Ainy, ElManial, Cairo, 11562 Egypt
| | - Ahmed Amin Nassar
- Otolaryngology Department, Al Kasr Al Ainy School of Medicine, Cairo University, Al Kasr Al Ainy, ElManial, Cairo, 11562 Egypt
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Wong SNS, Lau FTY, Chung JCK, Tsang RKY. Retrospective Review on Role of Neck Dissection in Laryngectomy of Patients With N0 Laryngeal Carcinoma. OTO Open 2022; 6:2473974X221127903. [PMID: 36171806 PMCID: PMC9511344 DOI: 10.1177/2473974x221127903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/04/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives The primary objective is to evaluate the incidence of occult nodal metastasis in patients undergoing total laryngectomy with cN0 disease. Other objectives are to compare the survival between different treatments of the neck, identify possible associated risk factors, and evaluate the effectiveness of elective neck dissection in this population with regards to oncological outcomes. Study Design Retrospective review. Setting Tertiary hospitals in Hong Kong. Methods Retrospective study was performed on patients who underwent total laryngectomy from 2008 to 2017 in New Territories West and Hong Kong West Clusters of the Hospital Authority of Hong Kong as primary or salvage treatment for cN0 squamous cell carcinoma (SCC) of the larynx. Incidence of neck dissection, incidence of nodal involvement, possible predictors, and oncological outcomes were analyzed. Results Seventy-seven patients were included, of whom 61 underwent either ipsilateral or bilateral neck dissection. Most (90.1%) of the patients with total laryngectomy done had locally advanced disease. Overall occult nodal metastasis rate was 20.6%, and only 3.8% of them had contralateral nodal metastasis. Occult nodal metastasis was significantly less in salvage laryngectomy (P = .045), while midline involvement and pT3/4 disease seem to be predictors for contralateral nodal metastasis. Conclusion There is significantly lower incidence of occult nodal metastasis in cN0 laryngeal SCC in the salvage setting, and occult contralateral nodal metastasis is not common in the cohort. Neck dissection during a salvage laryngectomy for cN0 disease could be avoided while contralateral neck dissection might be considered in cases of locally advanced disease with midline involvement.
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Affiliation(s)
- Stephanie Nga-sze Wong
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR
| | - Felix Tak-yin Lau
- Department of Otolaryngology, Yan Chai Hospital, Tsuen Wan, Hong Kong SAR
| | - Joseph Chun Kit Chung
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR
| | - Raymond King-yin Tsang
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR
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Salzano G, Perri F, Maglitto F, Togo G, De Fazio GR, Apolito M, Calabria F, Laface C, Vaira LA, Committeri U, Balia M, Pavone E, Aversa C, Salzano FA, Abbate V, Ottaiano A, Cascella M, Santorsola M, Fusco R, Califano L, Ionna F. Pre-Treatment Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios as Predictors of Occult Cervical Metastasis in Clinically Negative Neck Supraglottic and Glottic Cancer. J Pers Med 2021; 11:jpm11121252. [PMID: 34945723 PMCID: PMC8706672 DOI: 10.3390/jpm11121252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 11/30/2022] Open
Abstract
Background. Among patients with diagnosis of Laryngeal Squamous Cell Carcinoma (LSCC), up to 37.5% of cases may have occult metastasis (OM), and this feature is linked to poor prognosis and high rate of local recurrence. The role of elective neck dissection (END) in clinically negative neck (cN0) LSCC remains controversial. It is of great value to search for low-cost and easily detectable indicators to predict the risk of OM in laryngeal cancer. Recent reports have shown that high values of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) represent a negative prognostic factor in head and neck cancers. The aim of our study has been to investigate the value of pre-treatment NLR and PLR with regard to predicting occult cervical metastasis in cN0 supraglottic and glottic LSCC. Materials and methods. Data of patients affected by LSCC, who had been surgically treated by means of laryngectomy (total, horizontal partial and supracricoid) and END between January 2006 and January 2021, were retrospectively reviewed, using information retrieved from a database dedicated to such procedures in a single tertiary care referral institute. Results. A total of 387 patients were treated for LSCC at our Institute from 2006 to 2021, but only 108 of them met the inclusion criteria. The median age at the time of diagnosis was 64 years (range, 39–89 years). All the tumors were treated with a laryngectomy and an END. A total of 27.7% of patients were found positive for neck node metastasis (the pN+ group), while 78/108 (72.3%) patients were found to be negative for the presence of neck metastasis (the pN0 group). High values of NLR, but not PLR, significantly correlated with the probability of OM, and according to the iterative algorithm of Newton–Raphson, an NLR value of 2.26 corresponds to a probability of OM of 20%. Conclusion. Our analysis revealed a statistical correlation between high NLR pre-treatment values and positive neck OM in patients with LSCC.
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Affiliation(s)
- Giovanni Salzano
- Maxillo-Facial and ENT Surgery Unit, INT-IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (G.S.); (U.C.); (E.P.); (C.A.); (F.I.)
| | - Francesco Perri
- Head and Neck Medical and Experimental Oncology Unit, INT IRCCS Fondazione Giovanni Pascale, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-815-903-1734
| | - Fabio Maglitto
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, 80131 Naples, Italy; (F.M.); (G.T.); (G.R.D.F.); (M.A.); (F.C.); (C.L.); (V.A.); (L.C.)
| | - Giulia Togo
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, 80131 Naples, Italy; (F.M.); (G.T.); (G.R.D.F.); (M.A.); (F.C.); (C.L.); (V.A.); (L.C.)
| | - Gianluca Renato De Fazio
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, 80131 Naples, Italy; (F.M.); (G.T.); (G.R.D.F.); (M.A.); (F.C.); (C.L.); (V.A.); (L.C.)
| | - Michela Apolito
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, 80131 Naples, Italy; (F.M.); (G.T.); (G.R.D.F.); (M.A.); (F.C.); (C.L.); (V.A.); (L.C.)
| | - Federica Calabria
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, 80131 Naples, Italy; (F.M.); (G.T.); (G.R.D.F.); (M.A.); (F.C.); (C.L.); (V.A.); (L.C.)
| | - Claudia Laface
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, 80131 Naples, Italy; (F.M.); (G.T.); (G.R.D.F.); (M.A.); (F.C.); (C.L.); (V.A.); (L.C.)
| | - Luigi Angelo Vaira
- Maxillofacial Surgery Unit, University Hospital of Sassari, 07100 Sassari, Italy;
| | - Umberto Committeri
- Maxillo-Facial and ENT Surgery Unit, INT-IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (G.S.); (U.C.); (E.P.); (C.A.); (F.I.)
| | - Mario Balia
- Maxillofacial Surgery Unit, University of Naples Federico II, Via Sergio Pansini 5, 80131 Naples, Italy;
| | - Ettore Pavone
- Maxillo-Facial and ENT Surgery Unit, INT-IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (G.S.); (U.C.); (E.P.); (C.A.); (F.I.)
| | - Corrado Aversa
- Maxillo-Facial and ENT Surgery Unit, INT-IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (G.S.); (U.C.); (E.P.); (C.A.); (F.I.)
| | - Francesco Antonio Salzano
- Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy;
| | - Vincenzo Abbate
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, 80131 Naples, Italy; (F.M.); (G.T.); (G.R.D.F.); (M.A.); (F.C.); (C.L.); (V.A.); (L.C.)
| | - Alessandro Ottaiano
- SSD Innovative Therapies for Abdominal Metastases, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Naples, Italy; (A.O.); (M.S.)
| | - Marco Cascella
- Division of Anesthesia, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, 80131 Naples, Italy;
| | - Mariachiara Santorsola
- SSD Innovative Therapies for Abdominal Metastases, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Naples, Italy; (A.O.); (M.S.)
| | - Roberta Fusco
- Oncology Medical Division, Igea SpA, 80127 Naples, Italy;
| | - Luigi Califano
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, 80131 Naples, Italy; (F.M.); (G.T.); (G.R.D.F.); (M.A.); (F.C.); (C.L.); (V.A.); (L.C.)
| | - Franco Ionna
- Maxillo-Facial and ENT Surgery Unit, INT-IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy; (G.S.); (U.C.); (E.P.); (C.A.); (F.I.)
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Abstract
OPINION STATEMENT Dysplasia and early laryngeal cancer lie on a spectrum of cellular changes. These start with early changes to the cells including epithelial hyperplasia and expand to dysplasia, squamous cell carcinoma in situ and finally developing in to invasive cancer. Dysplasia can range from low to high grade, with each being treated in a different manner. Treatment options are typically determined by where the dysplasia/invasive cancer lie on this spectrum along with the site within the larynx. Hyperkeratosis, mild dysplasia and moderate dysplasia typically involve primary endoscopic excision. Severe dysplasia and squamous cell carcinoma in situ involve primary endoscopic resection with the addition of possible laser resection and/or ablation. At this stage, surgery will be followed by close surveillance. Finally, early laryngeal cancer such as T1 and T2 lesions is typically more involved. Treatment depends on the site and degree of involvement of the structures, along with spread to surrounding structures. Typical treatment options of more involved early laryngeal cancer can range from radiation therapy, endoscopic transoral laser resection, endoscopic transoral robotic resection to open resection. Often times, my choice of treatment will be aimed at voice preservation but patient preference will also play a role in the decision making between treatment modalities. Chemotherapy and immunotherapy are typically not used in early stage laryngeal cancer.
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Patterns of cervical lymph node metastasis in supraglottic laryngeal cancer and therapeutic implications of surgical staging of the neck. Eur Arch Otorhinolaryngol 2021; 278:5021-5027. [PMID: 33772318 PMCID: PMC8553708 DOI: 10.1007/s00405-021-06753-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 03/11/2021] [Indexed: 12/12/2022]
Abstract
Purpose Accurate therapeutic management of the neck is a challenge in patients with supraglottic laryngeal cancer. Nodal metastasis is common at all disease stages, and treatment planning relies on clinical staging of the neck, for both surgical and non-surgical treatment. Here, we compared clinical and surgical staging results in supraglottic carcinoma patients treated with primary surgery to assess the accuracy of pre-therapeutic clinical staging and guide future treatment decisions.
Methods Retrospective analysis of clinical, pathological, and oncologic outcome data of 70 patients treated with primary surgery and bilateral neck dissection for supraglottic laryngeal cancer. Patients where clinical and pathological neck staging results differed, were identified and analyzed in detail. Results On pathologic assessment, patients with early stage (pT1/2) primaries showed cervical lymph node metastases in 55% (n = 17/31) of cases, compared to 67% (n = 26/39) of patients with pT3/4 tumors. In 24% (n = 17/70) of all patients, cN status differed from pN status, resulting in an upstaging in 16% of cases (n = 11/70) and a downstaging in 9% (n = 6/70) of cases. 14% of patients with cN0 status had occult metastases (n = 5/30). As assessed by a retrospective tumor board, in case of a non-surgical treatment approach, the inaccurate clinical staging of the neck would have led to an over- or undertreatment of the neck in 20% (n = 14/70) of all patients. Conclusion Our data re-emphasize the high cervical metastasis rates of supraglottic laryngeal cancer across all stages. Inaccurate clinical staging of the neck is common and should be taken into consideration when planning treatment.
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Sharbel DD, Abkemeier M, Groves MW, Albergotti WG, Byrd JK, Reyes-Gelves C. Occult Metastasis in Laryngeal Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis. Ann Otol Rhinol Laryngol 2020; 130:67-77. [PMID: 32608245 DOI: 10.1177/0003489420937744] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The incidence of occult metastasis (OM) in laryngeal squamous cell carcinoma (SCC) is still widely debated. In this systematic review, we aim to determine the rate of OM in laryngeal SCC, its impact on recurrence, and the role of elective neck dissection (END) in the management of the clinically negative neck. METHODS A systematic review of the English-language literature in Web of Science, PubMed, MEDLINE, and Cochrane Library databases on occult metastasis in laryngeal SCC from 1977 to 2018 was conducted. Studies evaluating occult metastasis (OM) in patients with laryngeal SCC with clinically negative necks undergoing surgery were included. Studies evaluating other head and neck subsites, clinically node positive, and salvage patients were excluded. RESULTS Twenty-one articles with a total of 5630 patients were included. The overall rate of OM was 20.5% and was 23% and 12.2% in supraglottic and glottic tumors, respectively. The OM rate in T1-T2 tumors was 13% and 25% in T3-T4 tumors. T3-T4 tumors had significantly greater odds of developing OM compared to T1-T2 tumors (Odds Ratio [OR] = 2.61, 95% Confidence Interval [CI] = 1.92-3.55, P < .00001). Patients with OM were more likely to develop distant metastasis (OR = 5.65, 95% CI = 3.36-9.51, P < .00001). CONCLUSIONS Patients with advanced T-stage laryngeal SCC should undergo elective neck treatment. More aggressive treatment for patients with history of OM should be considered due to the risk of subsequent regional and distant metastasis. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Daniel D Sharbel
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Mary Abkemeier
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Michael W Groves
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - William G Albergotti
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - J Kenneth Byrd
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Camilo Reyes-Gelves
- Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia at Augusta University, Augusta, GA, USA
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Zhang Y, Xu S, Liu W, Wang X, Wang K, Liu S, Xu Z, Liu J. Rational choice of neck dissection in clinically N0 patients with supraglottic cancer. Head Neck 2019; 42:365-373. [PMID: 31724760 DOI: 10.1002/hed.26014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/06/2019] [Accepted: 10/30/2019] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The mainstay treatment of the neck for clinically negative neck (cN0) supraglottic laryngeal carcinoma (SGLC) is neck dissection. However, the optimal extent remains controversial. This study's purpose is to determine whether ipsilateral level II-III neck dissection is appropriate for cN0SGLC patients. METHODS The records of 220 consecutive untreated cN0SGLC patients were retrospectively reviewed. Relevant factors related to occult and contralateral neck metastasis were analyzed and the distribution of metastasis was described. RESULTS Seventy-seven and 143 patients underwent unilateral and bilateral neck dissection, respectively. The rate of occult neck metastases was 21.4%. The histologic differentiation was an independent risk factor for occult neck metastasis. In the bilateral neck dissection group, the incidence of contralateral neck metastasis of patients with noncentral tumors was 0.7%. Moreover, only 1.7% of patients had positive nodes at level IV, and no isolated nodal metastases existed in level IV. CONCLUSION Ipsilateral level II-III neck dissection is feasible for patients with noncentral cN0SGLC.
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Affiliation(s)
- Ye Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Siyuan Xu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Wensheng Liu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Xiaolei Wang
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Kai Wang
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Shaoyan Liu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Zhengang Xu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Jie Liu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
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10
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Wang SX, Ning WJ, Zhang XW, Tang PZ, Li ZJ, Liu WS. Predictors of Occult Lymph Node Metastasis and Prognosis in Patients with cN0 T1–T2 Supraglottic Laryngeal Carcinoma: A Retrospective Study. ORL J Otorhinolaryngol Relat Spec 2019; 81:317-326. [DOI: 10.1159/000503007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 08/27/2019] [Indexed: 11/19/2022]
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11
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Shi Y, Zhou L, Tao L, Zhang M, Chen XL, Li C, Gong HL. Management of the N0 neck in patients with laryngeal squamous cell carcinoma. Acta Otolaryngol 2019; 139:908-912. [PMID: 31343387 DOI: 10.1080/00016489.2019.1641219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Neck lymph node status is the chief prognostic index in patients with head and neck squamous cell carcinoma (SCC), yet the management of a clinically negative neck in this setting is still controversial, especially in patients with laryngeal SCC (LSCC). Objectives: To evaluate the efficacy of selective neck dissection (SND) to control occult disease in patients with LSCC and clinically negative (cN0) necks. Materials and methods: Medical records of 1476 patients with cN0 LSCC were analyzed. In conjunction with primary treatment, 126 (8.5%) underwent at least unilateral elective neck dissection, whereas most 1350 (91.5%) followed a wait-and-see protocol. Prognostic significance was indicated by the Kaplan-Meier survival estimates. Results: The rate of occult neck disease was 15%. Five-year overall and disease-free survival rates were 74.4% and 66.7%, respectively. Prognosis was closely related to T stage, preoperative tracheotomy, and postoperative recurrence. There was no significant correlation with age, sex, or preoperative neck dissection; but in patients with supraglottic LSCC, the relation between prognosis and preoperative neck dissection was significant, with fewer neck and local recurrences than the wait-and-see group (p < .05). Conclusions and significance: Selective neck dissection is serving as an accurate prognostic tool in patients with supraglottic laryngeal cancers.
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Affiliation(s)
- Yong Shi
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Liang Zhou
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Lei Tao
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Ming Zhang
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Xiao-Ling Chen
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Cai Li
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Hong-Li Gong
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
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12
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Ho AS, Maghami E. Surgical Perspectives in Head and Neck Cancer. Cancer Treat Res 2018; 174:103-122. [PMID: 29435839 DOI: 10.1007/978-3-319-65421-8_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Head and neck cancer treatment is a complex multidisciplinary undertaking. Cancer cure and survival is a primary goal, yet safe-guarding appearance and function to preserve the quality of life are similarly critical. The head and neck surgeon remains central to multidisciplinary cancer care, with deep knowledge of operative technique and an even deeper understanding of cancer biology. The surgeon models practice based on the highest levels of scientific evidence, but also takes into consideration the approaches that may best suit an individual patient. The surgeon's role moreover spans the life history of a head and neck cancer patient, from diagnosis to surveillance. The intimacy of this role makes the surgeon a trusted and frequent frame of reference for the patient. In this chapter, we provide an overview of the surgeon's role in head and neck cancer management. We discuss surgical perspectives within the multidisciplinary care team and selectively highlight some of the more provocative clinical scenarios in the field.
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Affiliation(s)
- Allen S Ho
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Ellie Maghami
- Department of Surgery, Division of Head and Neck Surgery, City of Hope National Medical Center, Duarte, USA.
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Ahn SH, Hong HJ, Kwon SY, Kwon KH, Roh JL, Ryu J, Park JH, Baek SK, Lee GH, Lee SY, Lee JC, Chung MK, Joo YH, Ji YB, Hah JH, Kwon M, Park YM, Song CM, Shin SC, Ryu CH, Lee DY, Lee YC, Chang JW, Jeong HM, Cho JK, Cha W, Chun BJ, Choi IJ, Choi HG, Lee KD. Guidelines for the Surgical Management of Laryngeal Cancer: Korean Society of Thyroid-Head and Neck Surgery. Clin Exp Otorhinolaryngol 2017; 10:1-43. [PMID: 28043099 PMCID: PMC5327593 DOI: 10.21053/ceo.2016.01389] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 10/24/2016] [Indexed: 01/08/2023] Open
Abstract
Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer. This Task Force conducted a systematic search of the EMBASE, MEDLINE, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to the key questions. Evidence-based recommendations were then created on the basis of these articles. An external expert review and Delphi questionnaire were applied to reach consensus regarding the recommendations. The resulting guidelines focus on the surgical treatment of laryngeal cancer with the assumption that surgery is the selected treatment modality after a multidisciplinary discussion in any context. These guidelines do not, therefore, address non-surgical treatment such as radiation therapy or chemotherapy. The committee developed 62 evidence-based recommendations in 32 categories intended to assist clinicians during management of patients with laryngeal cancer and patients with laryngeal cancer, and counselors and health policy-makers.
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Affiliation(s)
- Korean Society of Thyroid-Head and Neck Surgery Guideline Task Force
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Catholic Kwandong University College of Medicine, Incheon, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, University of Ulsan College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Chosun University College of Medicine, Gwangju, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Daejin Medical Center, Bundang Jesaeng Hospital, Seongnam, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Wonkwang University School of Medicine, Iksan, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Inje University College of Medicine, Busan, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Seonam University College of Medicine, Goyang, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Jun Hong
- Department of Otorhinolaryngology Head and Neck Surgery, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Soon Young Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Kee Hwan Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Jong-Lyel Roh
- Department of Otorhinolaryngology Head and Neck Surgery, University of Ulsan College of Medicine, Seoul, Korea
| | - Junsun Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Jun Hee Park
- Department of Otorhinolaryngology Head and Neck Surgery, Chosun University College of Medicine, Gwangju, Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Guk Haeng Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Sei Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jin Choon Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Hoon Joo
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Bae Ji
- Department of Otorhinolaryngology Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Jeong Hun Hah
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Minsu Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Young Min Park
- Department of Otorhinolaryngology Head and Neck Surgery, Daejin Medical Center, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Chang Myeon Song
- Department of Otorhinolaryngology Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Sung-Chan Shin
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Chang Hwan Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Doh Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Young Chan Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Won Chang
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Ha Min Jeong
- Department of Otorhinolaryngology Head and Neck Surgery, Wonkwang University School of Medicine, Iksan, Korea
| | - Jae-Keun Cho
- Department of Otorhinolaryngology Head and Neck Surgery, Inje University College of Medicine, Busan, Korea
| | - Wonjae Cha
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Byung Joon Chun
- Department of Otorhinolaryngology Head and Neck Surgery, Seonam University College of Medicine, Goyang, Korea
| | - Ik Joon Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Hyo Geun Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Kang Dae Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
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Cervical Metastases Behavior of T1-2 Squamous Cell Carcinoma of the Tongue. J Maxillofac Oral Surg 2016; 16:300-305. [PMID: 28717287 DOI: 10.1007/s12663-016-0936-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 06/17/2016] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION The cervical lymph node metastasis (CM) is one of the most important prognostic factors for oral squamous cell carcinoma. Although the frequency and distribution of CM for tongue carcinoma (TC) are well documented in the literature, there is only little data on metastasis patterns depending on the location of the cancer within the tongue. MATERIALS AND METHODS In a retrospective study all patients with a T1-T2 TC who were treated between 1997 and 2013 were analysed regarding epidemiological data, risk factors, and tumour parameters such as exact localization, CM. RESULTS 204 patients (59 ± 15 years; ♀37 %, ♂63 %) were included. At the initial diagnosis 23 % had an advanced tumour stage (III-IV) due to CM. The occurrence of CM was significantly higher for T2, advanced G-status and the localization in the posterior area of the tongue. The presence of CM-but not the recurrence-had a significant influence on the survival rate. CONCLUSION The small TC has an aggressive metastatic behaviour depending not only on the classical prognostic factors such as grading and tumour size, but is also strongly influenced by the posterior location within the tongue.
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Hypopharyngeal mucosal flap reconstruction in endoscopic supraglottic laryngectomy. Am J Otolaryngol 2013; 34:523-6. [PMID: 23886804 DOI: 10.1016/j.amjoto.2013.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 05/20/2013] [Accepted: 05/23/2013] [Indexed: 11/22/2022]
Abstract
PURPOSE Preservation of voice, swallowing and airway is mandatory in early to moderately advanced supraglottic cancers. Here, we propose an endoscopic laryngoplasty to improve swallowing recovery in patients treated by extended CO₂ laser supraglottic laryngectomy. METHODS We describe a new mucosal flap reconstruction technique in a cohort of seven laryngeal cancer patients with posterior extension, treated by CO₂ laser resection. Clinical endoscopic and videofluoroscopy postoperative exams were performed, and swallow function was tested by the MD Anderson Dysphagia Inventory (MDADI) questionnaire. RESULTS No early complications were observed. Absence of aspiration after two days in all cases was confirmed, and MDADI mean value result was 98. CONCLUSIONS We suggest the harvest of a hypopharyngeal mucosal flap in all patients who require a laryngeal supraglottic posterior resection, with or without arytenoidectomy.
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Sagheb K, Sagheb K, Taylor KJ, Al-Nawas B, Walter C. Cervical metastases of squamous cell carcinoma of the maxilla: a retrospective study of 25 years. Clin Oral Investig 2013; 18:1221-1227. [PMID: 23934238 DOI: 10.1007/s00784-013-1070-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 07/22/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Squamous cell carcinomas (SCCs) of the maxilla are relatively rare; therefore, only little data is available regarding the frequency of cervical metastasis (CM) and therapy strategies. Most authors only undertake clinical observation of the lymph nodes. The aim of this retrospective study was to evaluate the manner of metastasis in SCC of the maxilla. MATERIALS AND METHODS All patient records from 1987 to 2011 were scanned for SCC of the maxilla. Patients with SCC limited to the maxilla were comprised. The cases were analyzed regarding tumor node metastasis staging system and any special occurrences in the follow-up time such as tumor recurrence, metastasis, and exitus letalis. Classification and staging were performed according to the 2003 UICC system. RESULTS One hundred thirty-eight patients were comprised of 36 % females and 64 % males (average age, 66 years; women, 71 years; men, 63 years). The average follow-up time was 43 months (range, 0-195). Fifty-eight percent smoked or declared regular consumption of alcohol. About 50 % of the patients had an advanced tumor stage (III-IV). At the time of the primary diagnosis, 38 % of the patients had CM. There is an increased risk for CM occurrence with increasing tumor size and grading and a tumor localized in the postcanine region. Contralateral CM arises frequently in T4 tumors and tumors localized in the postcanine region. CONCLUSION The data exhibit aggressive regional metastatic behavior of SCC of the maxilla. CLINICAL RELEVANCE Therefore, surgical treatment of the draining lymphatic system as a primary management strategy is recommended for patients with SCC of the maxilla.
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Affiliation(s)
- K Sagheb
- Department of Oral and Maxillofacial Surgery, University Medical Center, Johannes Gutenberg-University of Mainz, Augustusplatz 2, 55131, Mainz, Germany.
| | - Ka Sagheb
- Department of Oral and Maxillofacial Surgery, University Medical Center, Johannes Gutenberg-University of Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - K J Taylor
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre, Johannes Gutenberg-University of Mainz, Obere Zahlbacher Str. 69, 55131, Mainz, Germany
| | - B Al-Nawas
- Department of Oral and Maxillofacial Surgery, University Medical Center, Johannes Gutenberg-University of Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - C Walter
- Department of Oral and Maxillofacial Surgery, University Medical Center, Johannes Gutenberg-University of Mainz, Augustusplatz 2, 55131, Mainz, Germany
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Ramalingam B, Ebenezer V. Retrospective analysis of survival of patients with squamous cell carcinoma of the maxilla after primary resection and elective bilateral neck dissection: An institutional experience. Ann Maxillofac Surg 2013; 1:42-7. [PMID: 23483114 PMCID: PMC3591043 DOI: 10.4103/2231-0746.83155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: A retrospective analysis of the 5-year survival rates of patients who underwent treatment for oral squamous cell carcinoma (OSCC) of the maxillary region was performed to analyse the prognostic factors for patient's survival. Materials and Methods: Twenty-four patients with SCC of the maxillary region, who underwent treatment at our hospital between 1999 and 2009 were included in the study. The patients underwent primary surgical resection and elective bilateral neck dissection. The patients with tumor positive margins were referred for chemo-radiotherapy after surgery. Results: The overall 5-year survival rate was 25%. The patients who had recurrence had presented with T3 or T4 lesions only. Of the patients who died, 14 out of the 18 were those who had tumor-positive margins and had undergone radiotherapy following surgery. Conclusions: Primary surgical treatment of SCCs of the maxillary region along with elective bilateral neck dissection yielded some improvement in survival rates, and can therefore be seen as a valuable strategy. Tumor-free resection margins and early detection of the lesion are the most important indicators for favorable prognosis.
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Affiliation(s)
- Balakrishnan Ramalingam
- Department of Oral and Maxillofacial Surgery, Sree Balaji Dental College and Hospital, Pallikaranai, Chennai, India
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Allegra E, Puzzo L, Zuccalà V, Trapasso S, Vasquez E, Garozzo A, Caltabiano R. Nuclear BMI-1 expression in laryngeal carcinoma correlates with lymph node pathological status. World J Surg Oncol 2012; 10:206. [PMID: 23031716 PMCID: PMC3500717 DOI: 10.1186/1477-7819-10-206] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 09/19/2012] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The main cause of treatment failure and death in laryngeal squamous cell carcinoma is metastasis to the regional lymph nodes. The current clinical staging criteria fail to differentiate patients with occult metastasis from patients without metastasis. Identifying molecular markers of the disease might improve our understanding of the molecular mechanisms underlying the pathogenesis and development of laryngeal carcinoma and may help improve clinical staging and treatment. METHODS Sixty-four previously untreated patients who underwent surgical excision of laryngeal squamous cell carcinoma with neck dissection were included in this study. The expression of B cell-specific Moloney murine leukemia virus integration site 1 (BMI-1) was examined immunohistochemically on formalin-fixed paraffin-embedded primary tissue specimens. RESULTS Nuclear expression of BMI-1 (nBMI-1) was detected in 32 of the 64 tumors (50%), cytoplasmic expression of BMI-1 (cBMI-1) was detected in 22 (34.4%), and 10 tumors (15.6%) showed no BMI-1 immunoreactivity. High nBMI-1 expression levels (≥ 10) were detected in 28 of the 32 (87.5%) nBMI-1-positive patients. Multivariate analysis including age at diagnosis, grade, tumor location, TNM status, and nBMI-1 expression showed that a high nBMI-1 expression level was an independent prognostic factor for lymph node metastasis. CONCLUSION The expression of BMI-1 in patients with laryngeal carcinoma seems to correlate with lymph node metastasis.
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Affiliation(s)
- Eugenia Allegra
- Department of Otolaryngology-Head and Neck Surgery, University of Catanzaro, Catanzaro, Italy
| | - Lidia Puzzo
- Department of Pathology, University of Catania, Catania, Italy
| | - Valeria Zuccalà
- Department of Pathology, University of Catanzaro, Catanzaro, Italy
| | - Serena Trapasso
- Department of Otolaryngology-Head and Neck Surgery, University of Catanzaro, Catanzaro, Italy
| | - Enrico Vasquez
- Department of Pathology, University of Catania, Catania, Italy
| | - Aldo Garozzo
- Department of Otolaryngology-Head and Neck Surgery, University of Catanzaro, Catanzaro, Italy
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Rodrigo JP, Shah JP, Silver CE, Medina JE, Takes RP, Robbins KT, Rinaldo A, Werner JA, Ferlito A. Management of the clinically negative neck in early-stage head and neck cancers after transoral resection. Head Neck 2010; 33:1210-9. [PMID: 21755564 DOI: 10.1002/hed.21505] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 04/14/2010] [Accepted: 05/03/2010] [Indexed: 11/11/2022] Open
Abstract
The decision regarding treatment of the clinically negative neck has been debated extensively. This is particularly true with early-stage tumors for which surgery is the treatment of choice, and the tumor has been resected transorally without a cervical incision. Elective neck dissection in this situation is an additional procedure with potential associated morbidity. The alternative strategy for the clinically negative neck is to "wait and watch." Both an elective neck dissection policy and a "watchful waiting" policy have their proponents. The purpose of this article was for us to review the literature about this subject to try to answer the following question: if the tumor has been resected transorally, should an elective treatment of the neck be performed or is a "watchful waiting" policy safe and adequate? We conclude that, currently, the best available evidence suggests that elective neck dissection does not seem to be superior to the policy of observation without neck surgery, with regard to survival and control of neck disease. This review highlights the need for further well-designed prospective studies that will provide more reliable answers to the debatable issue of the management of the clinically negative neck in such cases.
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Affiliation(s)
- Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
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Karatzanis AD, Psychogios G, Zenk J, Waldfahrer F, Hornung J, Velegrakis GA, Iro H. Evaluation of available surgical management options for early supraglottic cancer. Head Neck 2009; 32:1048-55. [DOI: 10.1002/hed.21289] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Gourin CG, Johnson JT. A contemporary review of indications for primary surgical care of patients with squamous cell carcinoma of the head and neck. Laryngoscope 2009; 119:2124-34. [DOI: 10.1002/lary.20619] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Surgical treatment of squamous cell carcinoma of the maxilla and nasal sinuses. J Oral Maxillofac Surg 2008; 66:2449-53. [PMID: 19022122 DOI: 10.1016/j.joms.2008.07.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2007] [Revised: 03/10/2008] [Accepted: 07/02/2008] [Indexed: 11/22/2022]
Abstract
PURPOSE In the treatment of oral squamous cell carcinoma of the maxilla and paranasal sinuses, radical surgery and reconstruction with free flaps is accepted among many clinics. Nevertheless, the treatment protocols vary considerably. This study was performed to present our experience in the treatment of maxillary squamous cell carcinoma with surgical means alone, and to try to identify crucial prognostic factors for the patients' survival. PATIENTS AND METHODS Thirty-six patients with primary resectable squamous cell carcinoma were included in the study. The mean age was 63 years (43-87 years) and 50% presented in advanced tumor stage (T4). Five patients (14%) already had cervical metastases. All patients were treated by radical surgery alone, and the resulting defects were closed by means of local or free flaps or the use of an obturator, respectively. RESULTS The overall 5-year survival rate was 64%; the recurrence rate was 33%. Only patients who presented in T3 or T4 stages or had no free resection margins died during the follow-up period. Sixty-nine percent of the patients who died passed away within the first 12 months of follow-up. The 5 patients with cervical metastases received therapeutic neck dissection and showed no regional recurrence. In cases of R1 resection, adjuvant radiotherapy was applied. CONCLUSIONS The sole surgical treatment of squamous cell carcinomas of the maxillary region led to good results, and can therefore be seen as a valuable strategy. Free resection margins and early detection of the tumor are the most important factors for success.
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Neck Dissection for Laryngeal Cancer. J Am Coll Surg 2008; 207:587-93. [DOI: 10.1016/j.jamcollsurg.2008.06.337] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Revised: 06/23/2008] [Accepted: 06/23/2008] [Indexed: 11/22/2022]
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Pablo Rodrigo J, Charlone R, Cabanillas R, Luis Llorente J, Suárez C. ¿Es necesario diferir los vaciamientos cervicales en las laringectomías supraglóticas con láser? ACTA OTORRINOLARINGOLOGICA ESPANOLA 2008. [DOI: 10.1016/s0001-6519(08)75554-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Management of clinically negative neck for the patients with head and neck squamous cell carcinomas in the modern era. Oral Oncol 2008; 44:817-22. [DOI: 10.1016/j.oraloncology.2007.12.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Revised: 08/03/2007] [Accepted: 12/04/2007] [Indexed: 02/08/2023]
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Rodrigo JP, Suárez C, Silver CE, Rinaldo A, Ambrosch P, Fagan JJ, Genden EM, Ferlito A. Transoral laser surgery for supraglottic cancer. Head Neck 2008; 30:658-66. [DOI: 10.1002/hed.20811] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Is it Necessary to Perform Neck Dissections as a Staged Procedure in Laser Supraglottic Laryngectomy? ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s2173-5735(08)70251-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Cağli S, Yüce I, Yiğitbaşi OG, Güney E. Is routine bilateral neck dissection absolutely necessary in the management of N0 neck in patients with supraglottic carcinoma? Eur Arch Otorhinolaryngol 2007; 264:1453-7. [PMID: 17624539 DOI: 10.1007/s00405-007-0384-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Accepted: 06/19/2007] [Indexed: 11/29/2022]
Abstract
The supraglottic larynx has a rich lymphatic network that places patients with supraglottic laryngeal carcinomas at high risk for early dissemination of the disease into the cervical lymphatics. Therefore, elective neck treatment of clinically N0 neck in patients with supraglottic carcinomas is widely accepted as a standard approach. However, the issue whether elective neck treatment should routinely be directed on both sides of the neck is still controversial. The present study is aimed at determining whether T2-T4 stage supraglottic carcinomas require bilateral neck dissection in the management of N0 necks. We designed a prospective study on 72 patients with N0 supraglottic laryngeal carcinoma. Patients were divided into three groups according to the site and extension of the primary tumors. Group I consisted of 21 patients with lateralized (clear lateral) lesion reaching but not crossing the midline. Group II comprised 25 patients with cancer largely involving one side and crossing to the midline. Group III included 26 patients with carcinoma equally involving both sides of the larynx or growth into the midline larynx. All patients underwent bilateral lateral neck dissection in conjunction with various types of laryngectomies selected to the status of the primary. Of the 72 patients, 16 were found to have occult regional metastases in pathologic examination (9 pN1, 4 pN2b, 3 pN2c). The prevalence of occult metastases proportionally increased with T stage from 8.3 to 22.7 and 31.2%, respectively, for T2, T3 and T4. Bilateral neck metastases were found in 2 of 26 patients (7.7%) with central lesions. There was only one patient (4%) with both ipsilateral and contralateral lymph node metastasis in group II. None of the 21 patients with lateral lesion (group I) had contralateral neck metastasis. Routine bilateral elective neck dissection may not be a part of the surgical procedure in all supraglottic laryngeal carcinoma patients. Bilateral neck dissection should be preferred for cases with central tumors and lateral tumors with positive nodes in the ipsilateral side of the neck.
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Affiliation(s)
- S Cağli
- Department of Otolaryngology, Head & Neck Surgery, Erciyes University Medical Faculty, Talas, Kayseri, Turkey.
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Simental AA, Johnson JT, Myers EN. Cervical Metastasis From Squamous Cell Carcinoma of the Maxillary Alveolus and Hard Palate. Laryngoscope 2006; 116:1682-4. [PMID: 16955004 DOI: 10.1097/01.mlg.0000233607.41540.28] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Squamous cell carcinoma has a predilection for regional lymphatic metastasis. The occurrence of occult cervical metastases from squamous cell carcinoma of the hard palate and maxillary alveolar ridge has not been studied systematically. We have observed many patients who have returned after resection of a primary cancer in these sites with a delayed cervical metastasis. Some of these patients have died of regional or distant metastasis despite control of their primary cancer. METHODS We have studied 26 patients with squamous cell carcinoma of the maxillary alveolar ridge and hard palate to define incidence of cervical metastasis. RESULTS Overall incidence of cervical metastasis was: clinical 2 of 26 (7.6%) and occult 7 of 26 (27%) for a total of 9 of 26 (34.6%). The 5-year disease-specific survival was 13 of 22 (59%). Surgery for regional failure was successful in 66% (6 of 9). Radiation was administered after surgery in eight of nine patients. CONCLUSION Cervical metastasis from cancer of the palate and alveolar ridge is significant. Regional surgery for recurrent disease usually requires radical or modified radical neck dissection. Selective elective neck dissection should be offered to patients with cancer of the hard palate and alveolar ridge. It affords the patient and the treatment team valuable histologic information, which may help to guide therapy and reduce the potential need for future hospitalization, chemoradiation, and more radical surgery.
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Affiliation(s)
- Alfred A Simental
- Department of Surgery, Loma Linda University, Loma Linda, California, USA.
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Rodrigo JP, Cabanillas R, Franco V, Suárez C. Efficacy of routine bilateral neck dissection in the management of the N0 neck in T1–T2 unilateral supraglottic cancer. Head Neck 2006; 28:534-9. [PMID: 16419080 DOI: 10.1002/hed.20359] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The treatment of the clinically negative (N0) neck in supraglottic laryngeal cancer continues to be an area of controversy. The aim of this study was to analyze the long-term efficacy of routine bilateral neck dissection compared with ipsilateral neck dissection in T1-T2 N0 lateral supraglottic carcinomas. METHODS A retrospective review of 108 patients who underwent surgery for T1-T2 supraglottic squamous cell carcinoma was performed. Forty-eight had undergone ipsilateral functional neck dissection, and 60 had undergone bilateral functional neck dissections. None of these patients received adjuvant radiotherapy. RESULTS No significant differences (p = .78) in regional recurrence were observed between the patients treated with bilateral neck dissection (13%) and those treated with ipsilateral neck dissection (17%). The 5-year survival rates were 73% and 80% for the patients who received a bilateral and ipsilateral neck dissection, respectively (p = .51). CONCLUSIONS This study suggests that routine bilateral neck dissection may not be necessary in the surgical treatment of all supraglottic cancers.
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Affiliation(s)
- Juan P Rodrigo
- Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, C/Celestino Villamil SN, 33006 Oviedo, Spain.
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