Olzowy Bernhard, Hillebrand Matthias, Harréus Ulrich
Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig Maximilians University of Munich Medical Center, Marchioninistr. 15, 81377, Munich, Germany.
HNO-Zentrum Landsberg, Ahornallee 2a, 86899, Landsberg, Germany.
Eur Arch Otorhinolaryngol. 2017 Nov;274(11):3965-3970. doi: 10.1007/s00405-017-4724-3. Epub 2017 Aug 24.
The decision whether to perform an elective neck dissection in patients with head and neck squamous cell carcinoma and clinically negative lymph nodes (cN0) is made based on the probability of micrometastases in the neck for the given subsite and size of the primary. A retrospective chart review was performed of 203 patients with hypopharyngeal SCC who received a bilateral neck dissection. The frequency of histologically unveiled bilateral neck metastases was determined. A high frequency of contralateral metastases above 20% was detected for all carcinomas affecting the midline and those involving the medial wall of the pyriform sinus except of T1-stages (13%) and a low frequency for laterally located primaries (3%). Ipsilateral nodal status predicted contralateral neck metastases. Bilateral neck dissection should be recommended for primaries affecting the midline and T2-4 tumors involving the medial wall of the pyriform sinus.
对于头颈部鳞状细胞癌且临床淋巴结阴性（cN0）的患者，是否进行择期颈部清扫术的决策是基于特定亚部位和原发灶大小的颈部微转移概率做出的。对203例接受双侧颈部清扫术的下咽鳞状细胞癌患者进行了回顾性病历审查。确定了组织学上发现的双侧颈部转移的频率。除T1期（13%）外，所有累及中线和梨状窦内侧壁的癌均检测到对侧转移频率高于20%，而外侧原发灶的转移频率较低（3%）。同侧淋巴结状态可预测对侧颈部转移。对于累及中线的原发灶以及T2 - 4期累及梨状窦内侧壁的肿瘤，应建议进行双侧颈部清扫术。
