Kraus D H, Rosenberg D B, Davidson B J, Shaha A R, Spiro R H, Strong E W, Schantz S P, Shah J P
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Am J Surg. 1996 Dec;172(6):646-9. doi: 10.1016/s0002-9610(96)00299-1.
Some patients undergoing surgical resection of primary squamous cell carcinoma of the oral cavity and oropharynx also undergo supraomohyoid neck dissection for staging of the negative (N(o)) neck. Dissection of the supraspinal accessory lymph node pad requires significant traction of the spinal accessory nerve. There are currently no data to indicate the incidence of metastases to this site and thus the necessity of performing dissection of these nodes.
A prospective analysis of a consecutive series of 44 patients with newly diagnosed squamous carcinoma of the oral cavity or oropharynx undergoing surgical management of the primary lesion with staging neck dissection was performed. Patients underwent unilateral (41) or bilateral (3) supraomohyoid neck dissection with separate submission of the supraspinal accessory lymph node pad for pathologic evaluation to determine the incidence of nodal metastases.
A total of 15 patients (32%) had microscopic metastatic squamous cell carcinoma involving the supraomohyoid neck dissection specimen. Only 1 patient had a metastatic deposit involving the supraspinal accessory lymph node pad. This patient also had metastases in additional lymph nodes at level II. There was an equal incidence of metastases for all patients when stratifying by T stage.
This preliminary report reveals a small incidence of supraspinal accessory lymph node metastases in patients with T + NO squamous cell carcinoma of the oral cavity and oropharynx. We continue to accrue patients to determine if the incidence of supraspinal accessory lymph node metastases varies with an increased number of patients.
一些接受口腔和口咽原发性鳞状细胞癌手术切除的患者，也会因阴性（N(0)）颈部分期而接受肩胛舌骨肌上颈清扫术。解剖副神经淋巴结垫需要对副神经进行显著牵拉。目前尚无数据表明该部位转移的发生率，因此也无法确定是否有必要对这些淋巴结进行清扫。
对连续44例新诊断为口腔或口咽鳞状细胞癌并接受原发性病变手术治疗及分期颈清扫术的患者进行前瞻性分析。患者接受单侧（41例）或双侧（3例）肩胛舌骨肌上颈清扫术，并分别送检副神经淋巴结垫进行病理评估，以确定淋巴结转移的发生率。
共有15例患者（32%）的肩胛舌骨肌上颈清扫术标本存在微小转移性鳞状细胞癌。仅有1例患者有累及副神经淋巴结垫的转移灶。该患者在Ⅱ区其他淋巴结也有转移。按T分期分层时，所有患者的转移发生率相同。
这份初步报告显示，口腔和口咽T + N0鳞状细胞癌患者中副神经淋巴结转移的发生率较低。我们继续纳入患者，以确定副神经淋巴结转移的发生率是否会随着患者数量的增加而变化。
