Kolli V R, Datta R V, Orner J B, Hicks W L, Loree T R
Department of Head and Neck Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY 14261, USA.
Arch Otolaryngol Head Neck Surg. 2000 Mar;126(3):413-6. doi: 10.1001/archotol.126.3.413.
Supraomohyoid neck dissection (SOHND) is currently used as a staging procedure for patients with clinically negative nodes in the neck who are at increased risk (>20%) for metastatic disease.
To assess the potential role of SOHND in patients with clinically positive nodes at levels I, II, or III. We evaluated, in particular, whether selective neck dissection in patients with clinically positive nodes results in decreased regional control and/or diminished survival.
We retrospectively reviewed the charts of all patients who underwent SOHND from January 1, 1971, to December 31, 1997. The oral cavity and oropharynx represented the primary sites in the majority of the patients. Two-year follow-up information was available on all patients.
During the study period, 69 patients underwent 84 SOHNDs. Of the 69 patients, there were 30 patients with clinically negative nodes and 39 patients with clinically positive nodes in the neck. The overall regional control rates were 88% vs 71% for pathologically negative vs positive nodes, respectively, with or without adjuvant radiation therapy. Adjuvant radiation therapy significantly improved regional control in patients with pathologically positive nodes but not in patients with NO disease (P = .005). Similar results were noted in patients with both clinically and pathologically positive nodes.
Supraomohyoid neck dissection in patients with pathologically positive nodes in the neck is inadequate therapy for regional control without postoperative radiation therapy. However, in patients with pathologically positive nodes in the neck, SOHND with postoperative radiation therapy can achieve regional control comparable to that of comprehensive neck dissection and postoperative radiation therapy.
舌骨上颈清扫术（SOHND）目前被用作颈部临床淋巴结阴性但发生转移疾病风险增加（>20%）患者的分期手术。
评估SOHND在颈部I、II或III区临床淋巴结阳性患者中的潜在作用。我们特别评估了临床淋巴结阳性患者进行选择性颈清扫术是否会导致区域控制率降低和/或生存率降低。
我们回顾性分析了1971年1月1日至1997年12月31日期间所有接受SOHND患者的病历。大多数患者的原发部位为口腔和口咽。所有患者均有两年的随访信息。
在研究期间，69例患者接受了84次SOHND。69例患者中，有30例患者颈部临床淋巴结阴性，39例患者颈部临床淋巴结阳性。无论有无辅助放疗，病理阴性与阳性淋巴结的总体区域控制率分别为88%和71%。辅助放疗显著提高了病理阳性淋巴结患者的区域控制率，但对无淋巴结转移（N0）疾病的患者无效（P = 0.005）。临床和病理均为阳性淋巴结的患者也有类似结果。
对于颈部病理阳性淋巴结的患者，若不进行术后放疗，舌骨上颈清扫术不足以控制局部区域。然而，对于颈部病理阳性淋巴结的患者，SOHND联合术后放疗可实现与全颈清扫术联合术后放疗相当的区域控制。
