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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 regional control rates by type of neck dissection (SMND versus RND) in clinically N1 necks. SMND: selective submandibular neck dissection; RND: radical neck dissection.
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fig3: The Kaplan-Meier 5-year regional control rates by type of neck dissection (SMND versus RND) in clinically N1 necks. SMND: selective submandibular neck dissection; RND: radical neck dissection.

Mentions: Among 68 patients who had clinically N1 necks with metastasis to level I, 32 underwent SMND and 36 underwent RND. The patient characteristics are shown in Table 2. Of the 32 patients who underwent SMND, 5 (including the cases of complete response on preoperative chemoradiotherapy) had histopathologically node-negative necks, and the other 27 had histopathologically positive necks, including 3 patients with multiple metastases at level I. Of the 36 patients who underwent RND, 6 had histopathologically N0 necks, 25 had pN1 (at level I) necks, and 5 had pN2b neck. Among these 5 patients, 2 had multiple nodal metastases at level I, 2 at level I and sublevel IIA, and one at level I, IIA, III. Eight (11.8%) of all 68 patients had occult nodal metastases, and no patients had skip metastasis to level III or IV or metastases to level IIB or IV. Six (18.8%) patients who underwent SMND and 6 (16.7%) who underwent RND had regional recurrence, leading to 5-year regional control rates of 81.3% and 83.0%, respectively, (P = 0.72) (Figure 3). Of the 6 patients who underwent SMND followed by regional recurrences, 4 had recurrences in the ipsilateral neck: 3 at level IIA and 1 at level IIA and III. The other 2 had recurrences at level I in the contralateral neck. Most of them experienced regional recurrences within 1 year. Of the 6 patients who underwent RND followed by regional recurrences, 1 had a recurrence in the parapharyngeal space of the ipsilateral neck, while 5 had recurrences in the contralateral neck: 2 at level I, 2 at level IIA, and 1 at level IIA, III. The 5-year DSS rate was 81.3% after SMND and 80.0% after RND, respectively, (P = 0.94) (Figure 4). On multivariate analysis, as in N0 neck, regional control and DDS were negatively associated with pathological nodal stage (pN2) and extracapsular spread and positively associated with administration of neoadjuvant chemoradiotherapy. The type of neck dissection did not significantly correlate with regional recurrence and DDS on either univariate or multivariate analysis (Table 4). Postoperative limited shoulder mobility was present in 11 (30.6%) of the 36 patients who underwent RND.


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 regional control rates by type of neck dissection (SMND versus RND) in clinically N1 necks. SMND: selective submandibular neck dissection; RND: radical neck dissection.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig3: The Kaplan-Meier 5-year regional control rates by type of neck dissection (SMND versus RND) in clinically N1 necks. SMND: selective submandibular neck dissection; RND: radical neck dissection.
Mentions: Among 68 patients who had clinically N1 necks with metastasis to level I, 32 underwent SMND and 36 underwent RND. The patient characteristics are shown in Table 2. Of the 32 patients who underwent SMND, 5 (including the cases of complete response on preoperative chemoradiotherapy) had histopathologically node-negative necks, and the other 27 had histopathologically positive necks, including 3 patients with multiple metastases at level I. Of the 36 patients who underwent RND, 6 had histopathologically N0 necks, 25 had pN1 (at level I) necks, and 5 had pN2b neck. Among these 5 patients, 2 had multiple nodal metastases at level I, 2 at level I and sublevel IIA, and one at level I, IIA, III. Eight (11.8%) of all 68 patients had occult nodal metastases, and no patients had skip metastasis to level III or IV or metastases to level IIB or IV. Six (18.8%) patients who underwent SMND and 6 (16.7%) who underwent RND had regional recurrence, leading to 5-year regional control rates of 81.3% and 83.0%, respectively, (P = 0.72) (Figure 3). Of the 6 patients who underwent SMND followed by regional recurrences, 4 had recurrences in the ipsilateral neck: 3 at level IIA and 1 at level IIA and III. The other 2 had recurrences at level I in the contralateral neck. Most of them experienced regional recurrences within 1 year. Of the 6 patients who underwent RND followed by regional recurrences, 1 had a recurrence in the parapharyngeal space of the ipsilateral neck, while 5 had recurrences in the contralateral neck: 2 at level I, 2 at level IIA, and 1 at level IIA, III. The 5-year DSS rate was 81.3% after SMND and 80.0% after RND, respectively, (P = 0.94) (Figure 4). On multivariate analysis, as in N0 neck, regional control and DDS were negatively associated with pathological nodal stage (pN2) and extracapsular spread and positively associated with administration of neoadjuvant chemoradiotherapy. The type of neck dissection did not significantly correlate with regional recurrence and DDS on either univariate or multivariate analysis (Table 4). Postoperative limited shoulder mobility was present in 11 (30.6%) of the 36 patients who underwent RND.

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