Andersen P E, Shah J P, Cambronero E, Spiro R H
Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10021.
Am J Surg. 1994 Nov;168(5):499-502. doi: 10.1016/s0002-9610(05)80110-2.
The most significant prognostic factor in patients with squamous cell carcinoma of the head and neck is the presence of cervical nodal metastases. Radical neck dissection is the standard by which all cervical lymphadenectomy procedures are judged. In the presence of clinically positive nodal metastasis, the benefit of preserving the spinal accessory nerve (SAN) has to be weighed against the possible risk of increased failure in the neck. We performed this retrospective study to determine if preservation of the SAN in patients with clinically evident nodal metastases was associated with increased risk of failure in the dissected neck.
Between January 1, 1984 and December 31, 1991, 378 comprehensive neck dissections were performed in 366 patients with clinically and pathologically positive nodal metastases from squamous carcinoma of the upper aerodigestive tract. We compared survival, neck control rates, and other factors in patients who had a classic radical neck dissection (RND) to those who had modified radical neck dissection sparing only the SAN (MRND I).
Actuarial 5-year survival and neck failure rates for the RND group were 63% and 12%, compared to 71% and 8% for the MRND I group (P = NS). Survival and neck failure were not statistically different between the MRND I and RND groups when the analysis controlled for pathologic N stage, presence of extra capsular spread, and the presence of pathologically demonstrated metastatic nodes along the course of the SAN. Nor were there significantly different patterns of neck failure with RND versus MRND.
Modification RND to preserve an uninvolved SAN in the clinically positive neck does not adversely affect survival or neck control.
头颈部鳞状细胞癌患者最重要的预后因素是颈部淋巴结转移的存在。根治性颈清扫术是评判所有颈部淋巴结清扫手术的标准。在临床确诊有淋巴结转移的情况下，必须权衡保留副神经（SAN）的益处与颈部复发风险增加的可能性。我们进行了这项回顾性研究，以确定在临床有明显淋巴结转移的患者中保留SAN是否与清扫侧颈部复发风险增加有关。
在1984年1月1日至1991年12月31日期间，对366例上消化道鳞状细胞癌临床及病理确诊有淋巴结转移的患者进行了378例根治性颈清扫术。我们比较了接受经典根治性颈清扫术（RND）的患者与仅保留SAN的改良根治性颈清扫术（MRND I）患者的生存率、颈部控制率及其他因素。
RND组的5年精算生存率和颈部复发率分别为63%和12%，而MRND I组为71%和8%（P = 无显著差异）。当分析控制病理N分期、包膜外扩散情况以及沿SAN走行有病理证实的转移淋巴结的情况时，MRND I组和RND组的生存率和颈部复发情况在统计学上无差异。RND与MRND的颈部复发模式也无显著差异。
在临床确诊有转移的颈部改良RND以保留未受累的SAN不会对生存或颈部控制产生不利影响。
