Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, India.
Eur J Surg Oncol. 2024 Oct;50(10):108547. doi: 10.1016/j.ejso.2024.108547. Epub 2024 Jul 14.
Perimarginal nodes (PMN) lie in close relationship with marginal mandibular nerve (MMN), in the lymphatic drainage pathway of gingivo-buccal cancers (GBC), above the lower border of mandible and remain unaddressed in conventional neck dissection. We have aimed to define the boundaries of perimarginal node dissection, explore incidence of PMN metastasis and its correlation with histopathological characteristics.
A prospective study was conducted on 112 consecutive patients of GB carcinoma. PMN dissection was performed in an anatomically defined quadrangle. Prospective clinical characteristics included subsite, tumor and nodal stage, location of primary and clinical skin involvement. Histopathological characteristics analyzed included grade, size, pathological tumor, nodal stage, skin and/or bone involvement, depth of invasion, Brandwein Gensler histological risk score and lympho-vascular emboli. MMN function was graded at 3 and 6 months post-operatively.
The PMN were identified histologically in 75.89 % patients. 15.2 % patients harboured metastasis in PMN. 16.7 % patients had clinically occult metastasis with 11.7 % having isolated PMN metastasis. None of the pre-operative clinical factors was found to be significant in predicting incidence of metastasis. Higher nodal burden (p = 0.01) and pathological skin involvement (p = 0.03) were found statistically significant on multivariable analysis. At 6 months follow-up, none of the patients had any MMN functional deformity at rest.
There is a high incidence of occult PMN metastasis from gingivo-buccal complex cancer. High nodal stage and pathological skin involvement are independent predictors for PMN metastasis. PMN dissection must be performed in all cases of GB cancer.
边缘旁淋巴结（PMN）与下颌缘神经（MMN）关系密切，位于下颌下缘之上，是牙龈-颊癌（GBC）的淋巴引流途径的一部分，但在常规颈部清扫术中并未涉及。我们旨在确定边缘旁淋巴结清扫的边界，探讨 PMN 转移的发生率及其与组织病理学特征的相关性。
对 112 例连续的 GBC 患者进行了一项前瞻性研究。在解剖定义的四边形内进行 PMN 解剖。前瞻性临床特征包括部位、肿瘤和淋巴结分期、原发灶和临床皮肤受累的位置。组织病理学特征分析包括分级、大小、病理肿瘤、淋巴结分期、皮肤和/或骨骼受累、浸润深度、Brandwein Gensler 组织学风险评分和淋巴管血管内瘤栓。在术后 3 个月和 6 个月对 MMN 功能进行分级。
75.89%的患者在组织学上可识别出 PMN。15.2%的患者在 PMN 中存在转移。16.7%的患者存在临床隐匿性转移，其中 11.7%的患者仅存在 PMN 转移。术前的临床因素均与转移的发生率无关。多变量分析显示，较高的淋巴结负担（p=0.01）和病理性皮肤受累（p=0.03）具有统计学意义。在 6 个月的随访中，没有患者在休息时出现任何 MMN 功能畸形。
从牙龈-颊部肿瘤中隐匿性 PMN 转移的发生率较高。高淋巴结分期和病理性皮肤受累是 PMN 转移的独立预测因素。在所有 GBC 患者中均应进行 PMN 清扫。
