Lohuis Peter J F M, Klop W Martin C, Tan I Bing, van Den Brekel Michiel W M, Hilgers Frans J M, Balm Alfons J M
Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
Am J Surg. 2004 Feb;187(2):295-9. doi: 10.1016/j.amjsurg.2003.11.015.
The use of selective neck dissection (SND) in the treatment of clinically node-positive necks remains controversial.
A total of 48 patients with laryngeal and hypopharyngeal carcinoma underwent 53 primary, therapeutic SNDs (levels II-V) and were retrospectively evaluated.
Regional metastases were staged as pN1 in 8 patients, pN2a in 3, pN2b in 29, and pN2c in 8. Of the primarily treated necks 45 of 53 (85%) were irradiated postoperatively. Extracapsular spread was found in 27 neck specimens (51%). Regional recurrences in level I occurred in one patient (1.8%) and in level II-V in 5 patients (9.4%). The actuarial overall survival at 4 years was 36.5%.
In selected cases therapeutic SND (levels II-V) in node positive (N1,2) patients with laryngeal or hypopharyngeal carcinoma does not lead to increased risk for recurrence in level I or other levels of the neck and is therefore a safe procedure.
在临床颈部淋巴结阳性患者的治疗中，选择性颈部淋巴结清扫术（SND）的应用仍存在争议。
共有48例喉癌和下咽癌患者接受了53次原发性治疗性SND（II - V区），并进行回顾性评估。
区域转移分期为pN1的患者有8例，pN2a的有3例，pN2b的有29例，pN2c的有8例。在接受初次治疗的颈部中，53例中有45例（85%）术后接受了放疗。27例颈部标本（51%）发现有包膜外扩散。I区区域复发1例（1.8%），II - V区区域复发5例（9.4%）。4年的精算总生存率为36.5%。
在特定病例中，对喉癌或下咽癌淋巴结阳性（N1、2）患者进行治疗性SND（II - V区）不会导致I区或颈部其他区域复发风险增加，因此是一种安全的手术。
