口腔癌治疗：仍然是选择性颈部淋巴结清扫术的适应症吗？
Oral Cancer Treatment: Still an Indication for Elective Neck Dissection?
作者信息
Koyama Leonardo Kenji Sakaue, Matos Leandro Luongo, Kulcsar Marco Aurélio Vamondes, de Araújo Filho Vergilius José Furtado, Cernea Claudio Roberto
机构信息
University of São Paulo, São Paulo, Brazil.
Head and Neck Surgery Discipline, Surgery Department, University of São Paulo, São Paulo, Brazil.
出版信息
ORL J Otorhinolaryngol Relat Spec. 2018;80(2):96-102. doi: 10.1159/000490253. Epub 2018 Jul 4.
INTRODUCTION
Oral squamous cell carcinoma has a high incidence and, although elective neck dissection is recommended, the removed nodes frequently present without metastasis. This surgical approach causes disabilities and increases possible surgical complications.
OBJECTIVE
To evaluate the possibility of a watchful waiting approach in oral cancer.
METHODS
We compared 78 patients with clinical and pathological node metastases and their counterparts with pathological node metastases but without evident clinical neck disease. Therefore, we provided a theoretical comparison between the patients who had an elective neck dissection and those who waited until a clinically positive node was evident.
RESULTS
The prognostic factor rates were similar between the groups. Their regional recurrence and mortality rates had no statistical differences.
CONCLUSION
A watchful waiting policy could be applied to selected oral cancer patients who can undergo a very close follow-up. This option would be more cost-effective and less harmful than elective neck dissection.
引言
口腔鳞状细胞癌发病率较高，尽管推荐进行选择性颈部清扫术，但切除的淋巴结常常无转移。这种手术方式会导致功能障碍并增加手术并发症的可能性。
目的
评估口腔癌患者采用观察等待策略的可能性。
方法
我们比较了78例有临床和病理淋巴结转移的患者以及病理淋巴结转移但无明显临床颈部病变的患者。因此，我们对接受选择性颈部清扫术的患者和等待至临床阳性淋巴结出现的患者进行了理论比较。
结果
两组之间的预后因素发生率相似。它们的区域复发率和死亡率无统计学差异。
结论
观察等待策略可应用于能够接受密切随访的部分口腔癌患者。与选择性颈部清扫术相比，这种选择更具成本效益且危害更小。
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