Mira Eugenio, Benazzo Marco, Rossi Vanessa, Zanoletti Elisabetta
Department of Otorhinolaryngology, University of Pavia, and IRCCS Policlinico S Matteo, Italy.
Otolaryngol Head Neck Surg. 2002 Oct;127(4):279-83. doi: 10.1067/mhn.2002.128601.
The purpose of this study was to evaluate the efficacy of selective neck dissection (SND) for elective treatment of the clinically negative neck in head and neck squamous cell carcinoma (SCC).
A retrospective review was undertaken on 91 previously untreated patients with T1-4 SCC of oral cavity (23), oropharynx (5), hypopharynx (7), larynx (56), and clinically negative neck (N0), undergoing 126 SND from January 1990 to March 1999 at a single institution. Twenty-five patients received postoperative radiation therapy on the basis of histologic evidence of >2 positive nodes, extracapsular spread (ECS), and/or the presence of advanced primary lesion.
On pathologic examination the average number of lymph nodes was 20.5 per neck, occult disease was detected in 14 (11.11%) of 126 necks; of necks with positive nodes, 6 (42.85%) of 14 had ECS. The median follow-up was 36 months. Overall recurrence rate (local, regional, and distant) was 12.8% (11 of 91). Recurrent disease developed in the neck of one patient, outside the dissected field. There was no difference in recurrence rate between pN0 and pN+ patients, as well as between pN+ with or without ECS. Overall survival rate was 84% (77 of 91), with a statistically significant difference between pN0 and pN+ necks.
SND seems to be a pragmatic approach that is as effective as comprehensive procedures for staging and treating the clinically negative neck.
本研究旨在评估选择性颈部清扫术（SND）对头颈部鳞状细胞癌（SCC）临床阴性颈部进行择期治疗的疗效。
对1990年1月至1999年3月在单一机构接受126例SND的91例既往未接受治疗的口腔（23例）、口咽（5例）、下咽（7例）、喉（56例）T1-4期SCC且临床阴性颈部（N0）患者进行回顾性分析。25例患者根据组织学证据显示有>2个阳性淋巴结、包膜外扩散（ECS）和/或存在晚期原发灶而接受术后放疗。
病理检查显示每个颈部平均淋巴结数为20.5个，126个颈部中有14个（11.11%）检测到隐匿性疾病；在有阳性淋巴结的颈部中，14个中有6个（42.85%）有ECS。中位随访时间为36个月。总复发率（局部、区域和远处）为12.8%（91例中的11例）。1例患者在颈部清扫区域外复发。pN0和pN+患者之间以及有或无ECS 的pN+患者之间复发率无差异。总生存率为84%（9
