Lörincz Balazs B, Langwieder Felix, Möckelmann Nikolaus, Sehner Susanne, Knecht Rainald
Head and Neck Cancer Centre of the Hubertus Wald University Cancer Centre Hamburg, Hamburg, Germany.
Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Eur Arch Otorhinolaryngol. 2016 May;273(5):1261-7. doi: 10.1007/s00405-015-3601-1. Epub 2015 Mar 18.
The nodal yield of neck dissections is an independent prognostic factor in several types of head and neck cancer. The authors aimed to determine whether the applied dissection technique has a significant impact on nodal yield. This is a single-institution, prospective study with internal control group (level of evidence: 2A). Data of 150 patients undergoing 223 neck dissections between February 2011 and March 2013 have been collected in a comprehensive cancer centre. Eighty-two patients underwent neck dissection with unwrapping the cervical fascia from lateral to medial, while 68 patients were operated without specifically unwrapping the fascia, in a caudal to cranial fashion. The standardised, horizontal neck dissection technique along the fascial planes resulted in a significantly higher nodal count in Levels I, II, III and IV, as well as in terms of overall nodal yield (mean: n = 22.53) than that of the vertical dissection applied in the control group (mean: n = 15.00). This is the first publication showing a direct correlation between neck dissection nodal yield and surgical technique. Therefore, it is paramount to optimise the applied surgical concept to maximise the oncological benefit.
颈部淋巴结清扫术的淋巴结清除量是几种头颈癌的独立预后因素。作者旨在确定所应用的清扫技术是否对淋巴结清除量有显著影响。这是一项单机构、有内部对照组的前瞻性研究（证据级别：2A）。2011年2月至2013年3月期间，在一家综合癌症中心收集了150例行223次颈部淋巴结清扫术患者的数据。82例患者采用从外侧向内侧剥离颈筋膜的方式进行颈部淋巴结清扫，而68例患者采用从尾侧向头侧的方式手术，未特意剥离筋膜。沿筋膜平面进行的标准化水平颈部淋巴结清扫技术在Ⅰ、Ⅱ、Ⅲ和Ⅳ区以及总的淋巴结清除量方面（平均：n = 22.53），均显著高于对照组采用的垂直清扫技术（平均：n = 15.00）。这是首次发表的表明颈部淋巴结清扫术的淋巴结清除量与手术技术之间存在直接关联的文章。因此，优化所应用的手术理念以最大化肿瘤学获益至关重要。
