Shin Yoo Seob, Kim Se-Heon, Koh Yoon Woo, Hong Hyun Jun, Seol Jeong Hun, Choi Eun Chang
Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea.
Acta Otolaryngol. 2011 Jun;131(6):665-9. doi: 10.3109/00016489.2011.554437. Epub 2011 Mar 14.
We suggest that contralateral level IV dissection is not necessary in patients with cN0 hypopharyngeal squamous cell carcinoma (HPSCC).
Elective treatment of neck nodes is very important in the management of cN0 HPSCC. A selective neck dissection neck level II to IV (SND II-IV) is widely accepted as an elective neck treatment of cN0 HPSCC. However, there has been a lot of effort to reduce the extent of surgery. Therefore, we investigated the incidence of level IV metastasis and regional recurrence in cN0 HPSCC.
We performed a retrospective review of 40 patients who underwent SND II-IV as an elective treatment for cN0 HPSCC from 1992 to 2010.
In all, 30 bilateral and 10 unilateral SND II-IVs were performed in 40 patients. Of the 70 SND II-IV specimens, 15 specimens from 14 patients (21%) were revealed to have positive lymph node metastasis. Level IV was involved in 3 of 70 necks (4.2%), but no isolated or contralateral level IV metastasis was observed. Every case that had level IV metastasis also had positive nodes in level II or III. There was no case of postoperative chylous leakage and only one case of phrenic nerve palsy.
我们认为，对于cN0期下咽鳞状细胞癌（HPSCC）患者，无需进行对侧IV区清扫。
在cN0期HPSCC的治疗中，颈部淋巴结的选择性治疗非常重要。选择性II至IV区颈部清扫术（SND II-IV）被广泛接受为cN0期HPSCC的选择性颈部治疗方法。然而，人们一直在努力减少手术范围。因此，我们研究了cN0期HPSCC患者IV区转移和区域复发的发生率。
我们对1992年至2010年间接受SND II-IV作为cN0期HPSCC选择性治疗的40例患者进行了回顾性研究。
40例患者共进行了30例双侧和10例单侧SND II-IV。在70个SND II-IV标本中，14例患者的15个标本（21%）显示有阳性淋巴结转移。70个颈部中有3个（4.2%）累及IV区，但未观察到孤立的或对侧IV区转移。每个有IV区转移的病例在II区或III区也有阳性淋巴结。没有术后乳糜漏的病例，只有1例膈神经麻痹。
