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Elective versus Therapeutic Neck Dissection in Node-Negative Oral Cancer
Published in Niall MH McLeod, Peter A Brennan, 50 Landmark Papers every Oral & Maxillofacial Surgeon Should Know, 2020
The tongue was the most common site for the primary tumour. In the elective surgery group, 174 patients underwent selective neck dissection and 60 underwent modified radical neck dissection. It is stated that 10 (5 + 5) patients in the elective surgery group did not undergo their assigned surgical treatment because they went elsewhere or due to “nonadherence.” This is despite the actual difference between 243 and 234 being 9.
The Head and Neck
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
Suprahyoid lymph node dissection is sometimes carried out for small mid-line lesions with high propensity for metastases. If metastases are encountered in the lymph nodes, total neck dissection on the afflicted side is in order. If bilateral neck dissections are required, it is preferable to perform a complete neck dissection of the prominent side of the primary and modified radical, i.e., with preservation of the internal jugular vein on the opposite side. Another approach would be to perform both standard and radical neck dissections on two separate settings about 2 weeks apart. Patients with cervical metastases from a controlled primary that refuse radical neck dissection can be treated by limited resection of the cervical metastases followed by radical neck irradiation. Conservative neck dissection in the form of resecting the anterior and posterior neck contents without removing any of the muscles can be utilized in elective neck dissection and certain cases.49
Surgical approach to thyroid disorders
Published in David S. Cooper, Jennifer A. Sipos, Medical Management of Thyroid Disease, 2018
Vaninder K. Dhillon, Ralph P. Tufano
The main risks of lateral neck dissection include shoulder weakness or palsy secondary to accessory nerve injury or stretching, facial droop, weakness of tongue movement, thoracic duct injury and subsequent chyle leak, Horner’s syndrome from sympathetic chain injury along the carotid sheath, seroma, hematoma, and infection (2). The risk of these complications is typically less than 5% (52); however, one prospective study described the rate of chyle leak to be 13.5% (53). A postoperative referral to a physical therapist for range of motion exercises, with continued outpatient therapy for most patients, also may be beneficial. Placement of patients on a regular diet within the first postoperative day is very helpful to rule out a chyle leak. Chyle leaks are diagnosed based upon the caliber and volume of output in neck drains placed at the time of surgery. Chylous output may be serous or milky with variability in output. To confirm the presence of chylous material, the fluid can be sent from drains in sterile containers and tested for amylase and lipase. If chylous output does not decrease with conservative management in the form of diet changes and octreotide, then surgical intervention may be necessary to ligate the thoracic duct or tributaries in order to prevent a chylothorax or infection (53, 54). A suction drain may be placed in each dissected lateral neck compartment to ameliorate the leak; they are typically removed within 5–7 days depending on output.
The timing and methods for detection of recurrence in patients with head and neck cancer
Published in Acta Oto-Laryngologica, 2023
Satoru Miyamaru, Kohei Nishimoto, Daizo Murakami, Kaoruko Kuraoka, Haruki Saito, Yorihisa Orita
In all cases, the treatment protocols were determined during cancer board meetings. Regarding the local tumour, all patients underwent tumour resection for oral cancer with or without flap reconstruction surgery depending on the primary tumour stage. In the oropharynx, hypopharynx, and larynx, we prioritized TOS for the maintenance of the patients’ quality of life. If complete resection could not be achieved with TOS, RT/CRT was applied. In case the tumour was too advanced to treat with RT/CRT, open surgery with or without reconstruction surgery was applied. Regarding the regional treatment of N0 cases, neck dissection was performed depending on the status of the primary tumour. Neck dissection was not performed for T1 oral cavity cancer and TOS cases. Contrastingly, neck dissection was routinely performed for all cancers above T3 except for glottal T3 cancer.
Emerging tyrosine kinase inhibitors for head and neck cancer
Published in Expert Opinion on Emerging Drugs, 2022
Zhen Long, Jennifer R. Grandis, Daniel E. Johnson
Surgical resection with curative intent remains the primary therapeutic approach for oral cavity cancers [1]. Most cancers that arise in the mouth can be removed with minimal morbidity with the exception of resections that involve the root of the tongue (such as a total glossectomy) and/or vascularized flap reconstruction. Neck dissection to remove the cervical lymph nodes (generally a selective or functional dissection to preserve other anatomic structures) is usually performed in conjunction with resecting the primary tumor to more accurately stage the tumor and remove any metastatic deposits in the neck. Despite extensive investigation of radiographic imaging and sentinel lymph node biopsy to avoid surgery for clinical N0 necks, neck dissections are still commonly performed in conjunction with primary tumor resection [15,16].
An examination of the cutoff value of the depth of invasion for prophylactic neck dissection in stage I/II tongue cancer
Published in Acta Oto-Laryngologica, 2020
Hoshino Terada, Eiichi Sasaki, Hidenori Suzuki, Daisuke Nishikawa, Shintaro Beppu, Nobuhiro Hanai
Matos et al. [4] showed that a tumor thickness greater than 10 mm was identified as an independent variable for a poor DFS. Mao et al. [18] reported the prognostic MRI depths that made it possible to identify nodal metastasis and OS to be 8 mm and 11 mm, respectively. Performing prophylactic neck dissection in all patients with a DOI of >4–5 mm would result in inflicting unnecessary insult in more than 60%–75% of patients with no metastasis and may constitute overtreatment. We must determine the need for prophylactic neck dissection in order to investigate whether or not we can establish less-invasive methods of observation. We believe it is important to examine whether or not follow-up is noninferior to prophylactic neck dissection by limiting the DOI and performing close follow-up with routine imaging examinations.