Zbären Peter, Nuyens Michel, Caversaccio Marco, Stauffer Edouard
Department of Otolaryngology, Head and Neck Surgery, University of Bern, Inselspital CH-3010 Bern, Switzerland.
Am J Surg. 2006 Jun;191(6):756-60. doi: 10.1016/j.amjsurg.2006.01.052.
Supraomohyoid neck dissection (SOHND) is currently performed in patients with carcinoma of the oral cavity with clinically negative neck. Most investigators consider SOHND as a staging procedure.
Records of 100 patients with cancer of the oral cavity and clinically negative neck undergoing SOHND were reviewed. The rate and significance of occult metastases are evaluated, the neck recurrences are analyzed and the indication of adjuvant radiation of pN+ necks is discussed.
In 34 of 1814 of analyzed lymph nodes, metastatic disease was detected as follows: 30 macrometastases and 4 micrometastases. In 13 of 34 metastases (38%), extracapsular spread was observed. Twenty of 100 patients (20%) had to be upstaged. In 9 of 87 (10%) patients without local recurrence and with a minimal follow-up of 24 months, 5 ipsilateral (4 within the dissection field) and 5 contralateral neck recurrences were observed. Regional recurrence developed in 4% and 35% of patients with pN0 and pN+ necks, respectively.
In 20% of patients with oral cavity tumors and pN0 neck, occult metastases were disclosed. Neck recurrences developed significantly more often in patients with pN+ than in those with pN0 necks. To evaluate the exact indication for an adjuvant treatment of patients with cN0/pN+ necks, prospective studies should be performed.
目前，舌骨上颈清扫术（SOHND）用于口腔癌且颈部临床检查阴性的患者。大多数研究者将SOHND视为一种分期手术。
回顾了100例口腔癌且颈部临床检查阴性并接受SOHND的患者记录。评估隐匿性转移的发生率及意义，分析颈部复发情况，并讨论pN+颈部辅助放疗的指征。
在1814个分析淋巴结中的34个中检测到转移性疾病，情况如下：30个大转移灶和4个微转移灶。在34个转移灶中的13个（38%）观察到包膜外扩散。100例患者中有20例（20%）分期上调。在87例无局部复发且最短随访24个月的患者中，9例（10%）观察到5例同侧（4例在清扫区域内）和5例对侧颈部复发。pN0和pN+颈部患者的区域复发率分别为4%和35%。
在20%的口腔肿瘤且pN0颈部患者中发现了隐匿性转移。pN+颈部患者的颈部复发明显多于pN0颈部患者。为评估cN0/pN+颈部患者辅助治疗的确切指征，应进行前瞻性研究。
