Teymoortash A, Werner J A
Department of Otolaryngology, Head & Neck Surgery, University of Marburg, Germany.
GMS Curr Top Otorhinolaryngol Head Neck Surg. 2012;11:Doc04. doi: 10.3205/cto000086. Epub 2012 Dec 20.
Still today, the status of the cervical lymph nodes is the most important prognostic factor for head and neck cancer. So the individual treatment concept of the lymphatic drainage depends on the treatment of the primary tumor as well as on the presence or absence of suspect lymph nodes in the imaging diagnosis. Neck dissection may have either a therapeutic objective or a diagnostic one. The selective neck dissection is currently the method of choice for the treatment of patients with advanced head and neck cancers and clinical N0 neck. For oncologic reasons, this procedure is generally recommended with acceptable functional and aesthetic results, especially under the aspect of the mentioned staging procedure. In this review article, current aspects on pre- and posttherapeutic staging of the cervical lymph nodes are described and the indication and the necessary extent of neck dissection for head and neck cancer is discussed. Additionally the critical question is discussed if the lymph node metastasis bears an intrinsic risk of metastatic development and thus its removal in a most possible early stage plays an important role.
直至今日，颈部淋巴结状态仍是头颈部癌症最重要的预后因素。因此，淋巴引流的个体化治疗方案取决于原发肿瘤的治疗情况以及影像诊断中可疑淋巴结的有无。颈部清扫术可能具有治疗目的或诊断目的。选择性颈部清扫术目前是治疗晚期头颈部癌症且临床颈部N0的患者的首选方法。出于肿瘤学原因，一般推荐采用该手术，其功能和美学效果可接受，特别是从上述分期手术的角度来看。在这篇综述文章中，描述了颈部淋巴结治疗前和治疗后的分期的当前情况，并讨论了头颈部癌症颈部清扫术的适应证和必要范围。此外，还讨论了一个关键问题，即淋巴结转移是否存在转移发展的内在风险，因此在尽可能早期将其切除起着重要作用。
