Shah Siddharth, Bhatt Aditi, Solanki Raghuvir, Thakkar Nirav, Shaikh Sakina, Patel Mahesh H
Department of Surgical Oncology, Zydus Hospital, Ahmedabad, Gujarat India.
Indian J Surg Oncol. 2020 Dec;11(4):589-596. doi: 10.1007/s13193-020-01252-x. Epub 2020 Oct 28.
Recent advances in minimal access/invasive surgeries in head and neck (robotic/endoscopic assisted) allow neck dissection without a visible scar through a retroauricular approach unlike conventional approach giving visible scar and its sequelae. We retrospectively reviewed prospectively collected data of 80 neck dissections in 72 patients from April 2017 to June 2018 for all newly diagnosed squamous cell carcinoma of oral cavity. We compared between the operative and postoperative outcomes in open- and endoscopic-assisted retroauricular approach (RA) in these patients undergoing neck dissections. Thirty-two out of seventy-two patients underwent retroauricular (RA) approach neck dissection while 40/72 patients underwent conventional open approach neck dissection. RA group had more early staged oral cancers 20/32 (62.5%) as compared to 9/40 (22.5%) in the open approach ( = 0.025). Average nodal yield and nodal yield according to levels were not statistically different in both groups. Nodal failure in both groups was also not statistically significant ( = 0.82). Postoperative complications like marginal weakness, hematoma, microvascular-related problems, and wound problems were not significantly related to the type of approach. We recommend in select group of early oral cancers the retroauricular-assisted neck dissection as minimally invasive, cost-effective, and oncologically safe approach for a scar-free neck surgery.
头颈部微创/侵入性手术(机器人/内镜辅助)的最新进展使得通过耳后入路进行颈部清扫时不会留下可见疤痕,这与会留下可见疤痕及其后遗症的传统方法不同。我们回顾性分析了2017年4月至2018年6月期间72例患者80次颈部清扫的前瞻性收集数据,这些患者均为新诊断的口腔鳞状细胞癌。我们比较了这些接受颈部清扫的患者采用开放式和内镜辅助耳后入路(RA)的手术和术后结果。72例患者中有32例行耳后(RA)入路颈部清扫,而40/72例患者行传统开放式颈部清扫。RA组早期口腔癌患者更多,为20/32(62.5%),而开放式入路组为9/40(22.5%)(P = 0.025)。两组的平均淋巴结收获量及按分区的淋巴结收获量在统计学上无差异。两组的淋巴结转移失败情况在统计学上也无显著差异(P = 0.82)。术后并发症如边缘性无力、血肿、微血管相关问题和伤口问题与手术入路类型无显著相关性。我们建议在部分早期口腔癌患者中,耳后辅助颈部清扫是一种微创、经济有效且肿瘤学安全的无疤痕颈部手术方法。