Basha Saleem Shaik, Nayak Vikash, Goel Ashish, Panda Sangram Keshari, Sharma Tapasvini Pradhan, Pande Pankaj Kumar, Kumar Kapil
HCG Curie City Cancer Centre, Vijayawada, India.
Jaypee Hospital Noida, Delhi, NCR India.
Indian J Surg Oncol. 2021 Dec;12(4):737-744. doi: 10.1007/s13193-021-01414-5. Epub 2021 Aug 18.
The oncological necessity of submandibular gland removal during neck dissection for oral cavity squamous cell carcinoma surgery has remained controversial. This study was aimed to determine the rate of SMG involvement and assess the feasibility of submandibular gland (SMG) preservation. We present a prospective study conducted at a tertiary cancer center from June 2017 to May 2019. All patients of oral squamous cell carcinoma who underwent primary surgery with neck dissection were included and analyzed for incidence and predictive factors for incidence of level IB nodal and SMG involvement as per CAP guidelines. A total of 60 patients were inducted in the study, wherein 63 neck dissections were performed including bilateral dissection in three cases. There was involvement of SMG in 6 patients with two cases each in floor of mouth cancer, gingivo-buccal, and alveolar lesions. The SMG was involved by direct contiguous spread from the primary lesion in two cases, extra-capsular extension from level IB lymph nodes in one and by both mode of spread in three glands. Perineural invasion was seen in 83.33% ( = 5) patients with SMG involvement (- < 0.001), while 66.67% (4/6) patients had lympho vascular invasion (-0.006) and all the cases with SMG involvement had extra-capsular extension ( < 0.001), suggesting PNI, LVI, and ECE as the strongest predictors of SMG involvement. This study demonstrates that oral cavity squamous cell carcinoma has low potential to metastasize to the SMG; however, high-risk factors include primary tumor site in floor of mouth or tongue, heavy level IB nodal burden, presence of LVI, PNI, and ECE. In the absence of these high-risk factors, SMG preservation with complete nodal clearance in level IB is a promising technique for reducing future complications.
在口腔鳞状细胞癌手术的颈部清扫术中，切除下颌下腺的肿瘤学必要性一直存在争议。本研究旨在确定下颌下腺受累率，并评估保留下颌下腺（SMG）的可行性。我们呈现了一项于2017年6月至2019年5月在一家三级癌症中心进行的前瞻性研究。纳入所有接受初次手术并进行颈部清扫的口腔鳞状细胞癌患者，并根据CAP指南分析IB区淋巴结和SMG受累的发生率及预测因素。共有60例患者纳入本研究，其中进行了63例颈部清扫，包括3例双侧清扫。6例患者的SMG受累，其中口底癌、牙龈颊侧和牙槽病变各2例。2例SMG受累是由于原发灶直接连续蔓延，1例是由于IB区淋巴结的包膜外扩展，3例是两种蔓延方式均有。83.33%（n = 5）的SMG受累患者出现神经周围侵犯（P < 0.001），而66.67%（4/6）的患者有淋巴管血管侵犯（P = 0.006），所有SMG受累病例均有包膜外扩展（P < 0.001），提示PNI、LVI和ECE是SMG受累的最强预测因素。本研究表明，口腔鳞状细胞癌转移至SMG的可能性较低；然而，高危因素包括口底或舌的原发肿瘤部位、IB区淋巴结负荷重、存在LVI、PNI和ECE。在没有这些高危因素的情况下，在IB区进行完整的淋巴结清扫并保留SMG是一种有望减少未来并发症的技术。
