Beppu Takeshi, Kamata Shin-etsu, Kawabata Kazuyoshi, Nigauri Tomohiko, Hoki Katsufumi, Mitani Hiroki, Yoshimoto Seiichi
Division of Head and Neck, Cancer Institute Hospital, Tokyo.
Nihon Jibiinkoka Gakkai Kaiho. 2002 Feb;105(2):178-87. doi: 10.3950/jibiinkoka.105.178.
We conducted definitive surgery on 45 patients with untreated primary parotid cancer from 1975 to 1995, and evaluated methods of neck dissection and results of treatment. All 14 with clinical neck lymph node metastasis underwent ipsilateral radical neck dissection and only 1 developed neck lymph node recurrence at the peripheral dissected site. Of 31 patients without clinical neck lymph node metastasis, 27 of 19 of 36 with high-grade malignancy and 12 of 24 with T3 or T4 did not undergo prophylactic neck dissection and developed latent neck lymph node metastasis in 2 cases (7.4%). Whereas in most cases we achieved good control of the primary site but neck lymph node recurrences occurred, recurrent sites were observed all around the ipsilateral neck and prognosis were very poor if neck dissection was conducted as secondary treatment. Although histopathological diagnosis was considered feasible for predicting occult neck lymph node metastasis, correct diagnostic with fine needle aspiration cytology revealed only 21.8%. Pathological positive lymph nodes in 15 patients who underwent neck dissection were detected all over (level I to V) the ipsilateral neck and the recurrent positive rate at level II was 100%. Based on the above results, we conclude that (1) in cases with neck lymph node metastasis in preoperative evaluation, ipsilateral radical neck dissection is mandated, and (2) in cases without neck lymph node metastasis, prophylactic neck dissection is not usually needed. When pathological results of frozen section from intraoperative jugulodigastric nodal sampling are positive, ipsilateral radical neck dissection is mandated.
1975年至1995年间，我们对45例未经治疗的原发性腮腺癌患者进行了根治性手术，并评估了颈部清扫方法和治疗结果。所有14例临床颈部淋巴结转移患者均接受了同侧根治性颈部清扫，仅1例在清扫部位周边出现颈部淋巴结复发。在31例无临床颈部淋巴结转移的患者中，36例高级别恶性肿瘤患者中的19例以及24例T3或T4患者中的12例未进行预防性颈部清扫，2例（7.4%）出现隐匿性颈部淋巴结转移。虽然在大多数情况下我们对原发部位实现了良好控制，但仍发生了颈部淋巴结复发，复发部位见于同侧颈部各处，若将颈部清扫作为二期治疗，预后很差。尽管组织病理学诊断被认为对预测隐匿性颈部淋巴结转移可行，但细针穿刺细胞学的正确诊断率仅为21.8%。15例接受颈部清扫患者的病理阳性淋巴结见于同侧颈部各处（I至V区），II区的复发阳性率为100%。基于上述结果，我们得出结论：（1）术前评估有颈部淋巴结转移的病例，必须进行同侧根治性颈部清扫；（2）无颈部淋巴结转移的病例，通常无需进行预防性颈部清扫。术中颈内静脉二腹肌淋巴结采样冰冻切片病理结果为阳性时，必须进行同侧根治性颈部清扫。
