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Retrospective Study of Selective Submandibular Neck Dissection versus Radical Neck Dissection for N0 or N1 Necks in Level I Patients with Oral Squamous Cell Carcinoma.

Yanai Y, Sugiura T, Imajyo I, Yoshihama N, Akimoto N, Kobayashi Y, Hayashi K, Fujinaga T, Shirasuna K, Takenoshita Y, Mori Y - J Oncol (2012)

Bottom Line: The Kaplan-Meier 5-year regional control and 5-year disease specific survival (DSS) were compared for SMND, radical neck dissection (RND), and modified radical neck dissection (MRND).Results.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Division of Maxillofacial Diagnostic and Surgical Sciences, Department of Oral and Maxillofacial Surgery, Graduate School of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.

ABSTRACT
Objective. To evaluate the efficacy of selective submandibular neck dissection (SMND) in patients with oral squamous cell carcinoma (OSCC) with or without nodal metastasis. Patients. From a total of 384 patients with untreated OSCC who underwent radical excision, we identified 229 with clinically N0 necks and 68 with clinically N1 necks in level I. Main Outcome Measures. The Kaplan-Meier 5-year regional control and 5-year disease specific survival (DSS) were compared for SMND, radical neck dissection (RND), and modified radical neck dissection (MRND). Results. In clinically node-negative necks, the regional control rates were 85.2% with SMND and 83.3% with MRND (P = 0.89), and 5-year DSS rates were 86.5% and 87.0%, respectively, (P = 0.94). In clinically N1 necks, the regional control rates were 81.3% with SMND and 83.0% with RND (P = 0.72), and the DSS rates were 81.3% and 80.0%, respectively, (P = 0.94). Type of neck dissection was not significantly associated with regional control or DSS on either univariate or multivariate analysis using Cox's proportional hazard model. Conclusions. SMND can be effectively applied in elective and therapeutic management to patients with OSCC that are clinically assessed as N0 or N1 to level I of the neck.

No MeSH data available.


Related in: MedlinePlus

The Kaplan-Meier 5-year disease-specific survival rates by type of neck dissection (SMND versus MRND) in clinically N0 necks. SMND: selective submandibular neck dissection; MRND: modified radical neck dissection.
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Related In: Results  -  Collection


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fig2: The Kaplan-Meier 5-year disease-specific survival rates by type of neck dissection (SMND versus MRND) in clinically N0 necks. SMND: selective submandibular neck dissection; MRND: modified radical neck dissection.

Mentions: Of 110 patients who underwent neck dissection, 77 (70%) underwent SMND and 33 (30%) underwent MRND. The patient characteristics are shown in Table 2. Positive nodes were identified histopathologically on the excised specimen in 5 (6.5%) of the 77 patients who underwent SMND and 4 (12.1%) of the 33 who underwent MRND. Among the 4 patients with positive nodes who underwent MRND, 2 had metastases at level I, one at level IIA, and one had multiple metastases at level I and IIA. No patient had evidence of “skip metastasis” to level III or IV or metastasis to level IIB or V. Occult metastases were present in 9 (8.2%) of all 110 patients, and the remaining 101 (91.8%) patients had histopathologically node-negative disease. Regional recurrences were documented in 11 (14.3%) patients who underwent SMND and 5 (15.1%) who underwent MRND, resulting in 5-year regional control rates of 85.2% and 83.3%, respectively, (P = 0.89) (Figure 1). Most of the nodal metastases in patients who underwent SMND were in the ipsilateral neck (8 at level IIA and 1 with multiple metastases at level IIA and III), while 2 were present at level I of the contralateral neck. Most of the patients with nodal metastases experienced regional recurrence within several months to a year. Only 1 patient who underwent MRND had regional recurrence in the ipsilateral neck (i.e., intraglandular parotid node, outside of the neck dissection), while 4 had recurrence in the contralateral neck: 2 at level I, 1 at level IIA, and 1 at level IIA and III. The 5-year DSS rate was 86.5% with SMND and 87.0% with MRND (P = 0.94) (Figure 2). On multivariate analysis (Table 3), regional control was negatively associated with pathological nodal stage (node-positive) and extracapsular spread and positively associated with administration of neoadjuvant chemoradiotherapy. DSS was negatively associated with clinical tumor stage, pathological nodal stage, extracapsular spread, and neoadjuvant chemoradiotherapy. Regional control and survival were not significantly associated with type of neck dissection on either univariate or multivariate analysis.


Retrospective Study of Selective Submandibular Neck Dissection versus Radical Neck Dissection for N0 or N1 Necks in Level I Patients with Oral Squamous Cell Carcinoma.

Yanai Y, Sugiura T, Imajyo I, Yoshihama N, Akimoto N, Kobayashi Y, Hayashi K, Fujinaga T, Shirasuna K, Takenoshita Y, Mori Y - J Oncol (2012)

The Kaplan-Meier 5-year disease-specific survival rates by type of neck dissection (SMND versus MRND) in clinically N0 necks. SMND: selective submandibular neck dissection; MRND: modified radical neck dissection.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3368397&req=5

fig2: The Kaplan-Meier 5-year disease-specific survival rates by type of neck dissection (SMND versus MRND) in clinically N0 necks. SMND: selective submandibular neck dissection; MRND: modified radical neck dissection.
Mentions: Of 110 patients who underwent neck dissection, 77 (70%) underwent SMND and 33 (30%) underwent MRND. The patient characteristics are shown in Table 2. Positive nodes were identified histopathologically on the excised specimen in 5 (6.5%) of the 77 patients who underwent SMND and 4 (12.1%) of the 33 who underwent MRND. Among the 4 patients with positive nodes who underwent MRND, 2 had metastases at level I, one at level IIA, and one had multiple metastases at level I and IIA. No patient had evidence of “skip metastasis” to level III or IV or metastasis to level IIB or V. Occult metastases were present in 9 (8.2%) of all 110 patients, and the remaining 101 (91.8%) patients had histopathologically node-negative disease. Regional recurrences were documented in 11 (14.3%) patients who underwent SMND and 5 (15.1%) who underwent MRND, resulting in 5-year regional control rates of 85.2% and 83.3%, respectively, (P = 0.89) (Figure 1). Most of the nodal metastases in patients who underwent SMND were in the ipsilateral neck (8 at level IIA and 1 with multiple metastases at level IIA and III), while 2 were present at level I of the contralateral neck. Most of the patients with nodal metastases experienced regional recurrence within several months to a year. Only 1 patient who underwent MRND had regional recurrence in the ipsilateral neck (i.e., intraglandular parotid node, outside of the neck dissection), while 4 had recurrence in the contralateral neck: 2 at level I, 1 at level IIA, and 1 at level IIA and III. The 5-year DSS rate was 86.5% with SMND and 87.0% with MRND (P = 0.94) (Figure 2). On multivariate analysis (Table 3), regional control was negatively associated with pathological nodal stage (node-positive) and extracapsular spread and positively associated with administration of neoadjuvant chemoradiotherapy. DSS was negatively associated with clinical tumor stage, pathological nodal stage, extracapsular spread, and neoadjuvant chemoradiotherapy. Regional control and survival were not significantly associated with type of neck dissection on either univariate or multivariate analysis.

Bottom Line: The Kaplan-Meier 5-year regional control and 5-year disease specific survival (DSS) were compared for SMND, radical neck dissection (RND), and modified radical neck dissection (MRND).Results.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Division of Maxillofacial Diagnostic and Surgical Sciences, Department of Oral and Maxillofacial Surgery, Graduate School of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.

ABSTRACT
Objective. To evaluate the efficacy of selective submandibular neck dissection (SMND) in patients with oral squamous cell carcinoma (OSCC) with or without nodal metastasis. Patients. From a total of 384 patients with untreated OSCC who underwent radical excision, we identified 229 with clinically N0 necks and 68 with clinically N1 necks in level I. Main Outcome Measures. The Kaplan-Meier 5-year regional control and 5-year disease specific survival (DSS) were compared for SMND, radical neck dissection (RND), and modified radical neck dissection (MRND). Results. In clinically node-negative necks, the regional control rates were 85.2% with SMND and 83.3% with MRND (P = 0.89), and 5-year DSS rates were 86.5% and 87.0%, respectively, (P = 0.94). In clinically N1 necks, the regional control rates were 81.3% with SMND and 83.0% with RND (P = 0.72), and the DSS rates were 81.3% and 80.0%, respectively, (P = 0.94). Type of neck dissection was not significantly associated with regional control or DSS on either univariate or multivariate analysis using Cox's proportional hazard model. Conclusions. SMND can be effectively applied in elective and therapeutic management to patients with OSCC that are clinically assessed as N0 or N1 to level I of the neck.

No MeSH data available.


Related in: MedlinePlus