Chheda Yogen P, Pillai Sundaram K, Parikh Devendra G, Dipayan Nandy, Shah Shakuntala V, Alaknanda Gupta
Department of Surgical Oncology, The Gujarat Cancer and Research Institute, Ahmedabad, Gujarat India.
Department of ENT, MY Medical College, Indore, India.
Indian J Surg Oncol. 2017 Jun;8(2):105-108. doi: 10.1007/s13193-014-0359-7. Epub 2014 Nov 13.
Oral cavity carcinoma is the most common cancer in Indian population. Metastatic nodal disease is the most important prognostic factor for oral cancers. In head and neck cancers with clinically N0 neck, standard selective neck dissection is performed by protecting the spinal accessory nerve to remove level IIA & IIB lymph nodes. The purpose of this study was to analyze the significance of level IIB dissection in patients of oral cavity cancer who underwent primary surgery with functional neck dissection. Two hundred ten patients with clinically N0 neck underwent neck dissection, where level IIB lymph nodes were dissected, labelled and processed separately. Among 210 patients of clinically N0 neck, 168 patients were pathologically N0 (80 %). Out of remaining 42 (20 %), 36 (17.14 %) were pN1 and 6 (2.86 %) were pN2. Among those with pN1 (36), level IB was involved in 24 patients (66.67 %) and level IIA was involved in 12 patients (33.33 %). Only 2 patients had involvement of level IIB lymph nodes. Among 6 patients of pN2 disease, 4 patients had simultaneous involvement of level IB and level IIA lymph nodes. Remaining 2 patients had isolated involvement of level III lymph nodes. Thus only 2 patients (< 1 %) out of 210 clinically N0 oral squamous cell carcinoma showed level IIB lymph node involvement. Thus we conclude that a frozen section of level 2a is advisable to decide the need for level 2b node dissection in clinically N0 neck as the sensitivity of clinical evaluation is extremely low.
口腔癌是印度人群中最常见的癌症。转移性淋巴结疾病是口腔癌最重要的预后因素。在临床上颈部为N0的头颈癌中，标准的选择性颈部清扫术是通过保护副神经来切除IIA和IIB级淋巴结。本研究的目的是分析在接受一期手术加功能性颈部清扫术的口腔癌患者中，IIB级清扫的意义。210例临床上颈部为N0的患者接受了颈部清扫术，其中IIB级淋巴结被清扫、标记并单独处理。在210例临床上颈部为N0的患者中，168例病理检查为N0（80%）。其余42例（20%）中，36例（17.14%）为pN1，6例（2.86%）为pN2。在pN1的患者（36例）中，24例（66.67%）累及IB级，12例（33.33%）累及IIA级。只有2例患者累及IIB级淋巴结。在6例pN2疾病患者中，4例同时累及IB级和IIA级淋巴结。其余2例孤立累及III级淋巴结。因此，在210例临床上颈部为N0的口腔鳞状细胞癌患者中，只有2例（<1%）显示IIB级淋巴结受累。因此我们得出结论，由于临床评估的敏感性极低，对于临床上颈部为N0的患者，建议对2a级进行冰冻切片检查以决定是否需要进行2b级淋巴结清扫。
