Beppu Takeshi, Kamata Shin-etsu, Kawabata Kazuyoshi, Nigauri Tomohiko, Mitani Hiroki, Yoshimoto Seiichi, Yonekawa Hiroyuki, Miura Kohki, Fukushima Hirofumi, Sasaki Tohru, Hamano Takahide, Tada Yuichirou, Hoki Katsufumi
Division of Head and Neck, Cancer Institute Hospital, Tokyo.
Nihon Jibiinkoka Gakkai Kaiho. 2003 Aug;106(8):831-7. doi: 10.3950/jibiinkoka.106.831.
The indication and preferred dissection field for prophylactic neck dissection for submandibular gland cancer are controversial and have not been standardized. We reviewed 27 patients who underwent a definitive operation for previously untreated submandibular gland cancer. The 27 patients consisted of 13 patients with adenoid cystic carcinoma, 6 patients with mucoepidermoid carcinoma, 6 patients with adenocarcinoma, and 2 patients with squamous cell carcinoma. The diagnostic accuracies of malignancy and histology with fine needle aspiration cytology were 86% and 56%, respectively. In sixteen out of 21 cases without neck lymph node metastasis, a prophylactic neck dissection was performed and pathological neck lymph node metastases were detected in five cases. On the other hand, in five cases that did not receive a prophylactic neck dissection, latent neck lymph node metastasis was observed in 2 cases. In both cases of neck lymph node metastasis, pathological positive lymph nodes were observed in only level 2 or level 3. The rates of occult neck lymph node metastasis according to the T stage were 0% in T1, 33.3% in T2, 57.1% in T3 and 100% in T4. The rates of occult neck lymph node metastasis according to the histopathology were 46.2% in adenoid cystic carcinoma, 50% in mucoepidermoid carcinoma, 50% in adenocarcinoma, and 50% in squamous cell carcinoma. In conclusion, we believe that supraomyohoid neck dissection is suitable for N0 cases of submandibular gland cancer because of four reasons: 1) rate of occult neck lymph node metastasis in submandibular gland cancer is high, 2) pathological neck lymph node metastasis in N0 cases and latent neck lymph node metastasis were observed in level 2 and level 3, 3) the prognosis of cases with neck lymph node metastasis was poor, and 4) same skin incision can be used not only for the primary resection but also for the neck dissection.
下颌下腺癌预防性颈清扫术的指征和首选解剖区域存在争议，尚未标准化。我们回顾了27例接受初次手术治疗的未经治疗的下颌下腺癌患者。这27例患者包括13例腺样囊性癌、6例黏液表皮样癌、6例腺癌和2例鳞状细胞癌。细针穿刺细胞学检查对恶性肿瘤和组织学的诊断准确率分别为86%和56%。在21例无颈部淋巴结转移的病例中，16例进行了预防性颈清扫术，其中5例检测到病理性颈部淋巴结转移。另一方面，在5例未接受预防性颈清扫术的病例中，2例观察到潜在的颈部淋巴结转移。在这两例颈部淋巴结转移病例中，仅在2区或3区观察到病理性阳性淋巴结。根据T分期，隐匿性颈部淋巴结转移率在T1期为0%，T2期为33.3%，T3期为57.1%，T4期为100%。根据组织病理学，隐匿性颈部淋巴结转移率在腺样囊性癌中为46.2%，黏液表皮样癌中为50%，腺癌中为50%，鳞状细胞癌中为50%。总之，我们认为肩胛舌骨肌上颈清扫术适用于下颌下腺癌的N0病例，原因有四点：1）下颌下腺癌隐匿性颈部淋巴结转移率高；2）在N0病例中，病理性颈部淋巴结转移和潜在的颈部淋巴结转移在2区和3区被观察到；3）颈部淋巴结转移病例的预后较差；4）相同的皮肤切口不仅可用于原发灶切除，也可用于颈清扫术。
