Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College and Hospital, Manipal, Manipal Academy of Higher Education, Udupi, India.
Department of Surgical Oncology, Manipal Comprehensive Cancer Care Center, Kasturba Hospital, Manipal Academy of Higher Education, Udupi, India.
J Laryngol Otol. 2021 Apr;135(4):359-366. doi: 10.1017/S0022215121000621. Epub 2021 Mar 15.
Lymph node yield is an important prognostic factor in head and neck squamous cell carcinoma. Variability in neck dissection sampling techniques has not been studied as a determinant of lymph node yield.
This retrospective study used lymph node yield and average nodes per level to compare level-by-level and en bloc neck dissection sampling methods, in primary head and neck squamous cell carcinoma cases operated between March 2017 and February 2020.
From 123 patients, 182 neck dissections were analysed, of which 133 were selective and the rest were comprehensive: 55 had level-by-level sampling and 127 had undergone en bloc dissection. The level-by-level method yielded more nodes in all neck dissections combined (20 vs 17; p = 0.097), but the difference was significant only for the subcohort of selective neck dissection (18.5 vs 15; p = 0.011). However, the gain in average nodes per level achieved by level-by-level sampling was significant in both groups (4.2 vs 3.33 and 4.4 vs 3, respectively; both p < 0.001).
Sampling of cervical lymph nodes level-by-level yields more nodes than the en bloc technique. Further studies could verify whether neck dissection sampling technique has any impact on survival rates.
淋巴结产量是头颈部鳞状细胞癌的一个重要预后因素。尚未研究颈部解剖取样技术的变异性是否为淋巴结产量的决定因素。
本回顾性研究使用淋巴结产量和每个水平的平均淋巴结，比较了分层和整块颈部解剖取样方法，在 2017 年 3 月至 2020 年 2 月期间对原发性头颈部鳞状细胞癌病例进行了手术。
从 123 例患者中，分析了 182 例颈部解剖，其中 133 例为选择性，其余为综合性：55 例行分层取样，127 例行整块解剖。分层方法在所有颈部解剖中都产生了更多的淋巴结（20 对 17；p = 0.097），但仅在选择性颈部解剖的亚组中差异具有统计学意义（18.5 对 15；p = 0.011）。然而，分层取样的平均每个水平的淋巴结数的增加在两组中均具有统计学意义（分别为 4.2 对 3.33 和 4.4 对 3；均 p < 0.001）。
分层取样比整块技术能获得更多的淋巴结。进一步的研究可以验证颈部解剖取样技术是否对生存率有任何影响。
