Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California, San Diego, San Diego, California, USA.
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Commonwealth Health Center, Saipan, Northern Mariana Islands.
Head Neck. 2020 Sep;42(9):2355-2363. doi: 10.1002/hed.26248. Epub 2020 May 19.
Recurrent head and neck squamous cell carcinoma (HNSCC) after radiation is associated with poor survival, and management of the clinically negative (N0) neck during salvage surgery is controversial.
Studies were selected according to preferred reporting items for systematic reviews and meta-analyses guidelines. Inclusion criteria were patients with HNSCC, prior radiation to the lateral neck nodal basin, undergoing salvage surgery for local recurrence, persistence or second primary, and N0 at time of salvage. Eleven studies with a total of 382 patients met inclusion criteria.
The rate of occult metastasis was 15.4%. The pooled rate of occult nodal metastasis was 16.2% for oral cavity, 12.9% for oropharynx, 23.7% for hypopharynx, and 27.3% for supraglottic or transglottic tumors. There was a significantly higher relative risk of occult metastasis for locally advanced tumors.
Elective neck dissection at time of salvage surgery should be considered based on subsite, T classification, and prior history of nodal metastasis.
放疗后复发性头颈部鳞状细胞癌（HNSCC）与生存率差相关，挽救性手术中对临床阴性（N0）颈部的处理存在争议。
根据系统评价和荟萃分析的首选报告项目选择研究。纳入标准为接受过侧颈部淋巴结区放射治疗、因局部复发、持续存在或第二原发灶而行挽救性手术且挽救性手术时 N0 的 HNSCC 患者。共有 11 项研究共 382 例患者符合纳入标准。
隐匿性转移率为 15.4%。口腔癌隐匿性淋巴结转移率为 16.2%，口咽癌为 12.9%，下咽癌为 23.7%，声门上型或跨声门型肿瘤为 27.3%。局部晚期肿瘤隐匿性转移的相对风险显著更高。
应根据部位、T 分类和既往淋巴结转移史，考虑在挽救性手术时行选择性颈部清扫术。
