Lippert Dylan, Dang Phat, Cannon Donald, Harari Paul M, McCulloch Timothy M, Hoffman Matthew R, Hartig Gregory K
1 Department of Surgery-Division of Otolaryngology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
2 Department of Human Oncology, Madison, University of Wisconsin School of Medicine and Public Health, Wisconsin, USA.
Ann Otol Rhinol Laryngol. 2017 Nov;126(11):762-767. doi: 10.1177/0003489417730839. Epub 2017 Sep 26.
Lymph node yield in therapeutic neck dissection is clinically significant and incompletely studied. We quantified node yield based on extent of neck dissection and presence of preoperative radiation. We also evaluated factors affecting incidence of extracapsular spread (ECS).
Retrospective review of 499 patients undergoing therapeutic neck dissection; 414 patients met inclusion criteria and were divided into 2 groups: neck dissection alone or before radiation (surgery first: 280 patients; 385 dissections) and primary radiation before surgery (radiation first: 134 patients; 157 dissections). Node yield relative to levels dissected and incidence of ECS were examined.
Dissection-specific node yield was greater in the surgery first group for dissection of levels I-V (31.1 ± 16.7 vs 24.0 ± 14.7, P < .001) and levels II-V (26.7 ± 14.4 vs 21.1 ± 10.7). Extracapsular spread incidence was 32.1% (98/305) in the surgery first group and 15.4% (23/149) in the radiation first group ( P < .001).
This study clarifies anticipated node yield based on number of levels dissected and presence of preoperative radiation. Node yield and incidence of ECS are lower in patients undergoing preoperative radiation.
治疗性颈部清扫术中的淋巴结收获量具有临床意义，但尚未得到充分研究。我们根据颈部清扫范围和术前放疗情况对淋巴结收获量进行了量化。我们还评估了影响包膜外扩散（ECS）发生率的因素。
对499例行治疗性颈部清扫术的患者进行回顾性研究；414例患者符合纳入标准，分为2组：单纯颈部清扫或放疗前清扫（先手术组：280例患者；385次清扫）和手术前行根治性放疗（先放疗组：134例患者；157次清扫）。检查相对于清扫水平的淋巴结收获量和ECS发生率。
先手术组在清扫I-V区（31.1±16.7对24.0±14.7，P<.001）和II-V区（26.7±14.4对21.1±10.7）时，特定清扫区域的淋巴结收获量更大。先手术组的包膜外扩散发生率为32.1%（98/305），先放疗组为15.4%（23/149）（P<.001）。
本研究根据清扫水平数量和术前放疗情况明确了预期的淋巴结收获量。术前放疗患者的淋巴结收获量和ECS发生率较低。
