Department of Otolaryngology, Head and Neck Surgery, Philipp University, Marburg, Germany.
Am J Otolaryngol. 2012 Sep-Oct;33(5):505-9. doi: 10.1016/j.amjoto.2011.11.005. Epub 2012 Jan 2.
Patients with surgically treated head and neck cancer and clinical N0 neck with high risk of occult lymph node metastasis undergo elective neck dissection (ND). Late lymph node metastasis may appear in those patients with pN0 neck. The aim of the present study was to analyze the incidence and clinical relevance of late lymph node metastasis in patients with head and neck cancer.
The clinical data of 61 patients with head and neck cancer who had undergone elective ND with pN0 neck were retrospectively analyzed. Only patients without local failure, second primary, or radiochemotherapy were included in the study.
Late lymph node metastasis could be observed in 4 (6.5%) cases at the margin or outside the initially dissected lymph node levels. In those patients, the primary tumor was localized in the oral cavity (n = 3) or oropharynx (n = 1) and was classified in all cases as T1 or T2. Lymph node metastasis could be found in levels I (n = 2), II (n = 1), and IV (n = 1), respectively.
Even in the case of pN0 neck after an elective ND, the appearance of late lymph node metastases must be expected. The low proportion of patients with late lymph node metastases after a selective ND in clinical and histologic N0 does not justify an extended form of neck surgery.
接受手术治疗的头颈部癌症患者和临床 N0 颈部伴有隐匿性淋巴结转移高风险的患者需要进行选择性颈部清扫术（ND）。那些临床 N0 颈部的患者可能会出现迟发性淋巴结转移。本研究旨在分析头颈部癌症患者迟发性淋巴结转移的发生率和临床相关性。
回顾性分析了 61 例接受选择性 pN0 颈部 ND 的头颈部癌症患者的临床资料。仅纳入无局部复发、第二原发肿瘤或放化疗的患者。
在 4 例（6.5%）患者中，在最初清扫的淋巴结水平的边缘或外部可观察到迟发性淋巴结转移。这些患者的原发肿瘤位于口腔（n=3）或口咽（n=1），所有病例均为 T1 或 T2 期。淋巴结转移可分别在 I 区（n=2）、II 区（n=1）和 IV 区（n=1）发现。
即使在选择性 ND 后的 pN0 颈部，也必须预期迟发性淋巴结转移的出现。选择性 ND 后临床和组织学 N0 患者中迟发性淋巴结转移的比例较低，这并不支持采用扩展型的颈部手术。
