Talmi Y P, Hoffman H T, Horowitz Z, McCulloch T M, Funk G F, Graham S M, Peleg M, Yahalom R, Teicher S, Kronenberg J
Department of Otolaryngology-Head and Neck Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel.
Head Neck. 1998 Dec;20(8):682-6. doi: 10.1002/(sici)1097-0347(199812)20:8<682::aid-hed4>3.0.co;2-j.
Cervical lymphadenectomy to remove metastatic disease in level II encompasses lymph nodes associated with the upper third of the internal jugular vein and the adjacent spinal accessory nerve (SAN). Conservative neck dissection (ND) preserves these structures but requires manipulation of the SAN to remove tissue located in the posterosuperior aspect of level II. Limiting the dissection to the nodal group anterior to the SAN may reduce operating time and limit injury to it without compromising the removal of lymph nodes at risk for involvement with cancer.
Seventy-one patients with squamous cell carcinoma of the head and neck treated with cervical lymphadenectomy at two separate institutions were prospectively evaluated. One hundred two neck dissection specimens were histologically analyzed for number of lymph nodes present and number involved with cancer. At the time of surgery, level II was separated into the supraspinal accessory nerve component (IIa) and the component anterior to the SAN (IIb). Nodal involvement in level II was analyzed according to characteristics of the cancer at the primary site as well as nodal involvement of other levels.
Neck dissections were most commonly done for cancer of the oral cavity (n = 33), followed in frequency by the larynx (n = 17), oropharynx (n = 7), skin of face (n = 4), unknown primary (n = 4), and other sites (n = 6). Eighty NDs were selective and 22 were either radical or modified radical NDs. Pathologic staging of the neck specimen was most commonly N0 (n = 61), followed in frequency by N1 (n= 17), N2 (n= 11), and N3 (n= 11). Data were unclear for two specimens. Level IIb contained an average of 6.9 nodes and the IIa component contained an average of 4.2 nodes. Level II contained metastatic disease in 31 of 39 node positive specimens (79%). Level IIa was involved with cancer in four cases, all of which were preoperatively staged N2 or greater.
The additional time required and morbidity associated with dissection of the supraspinal accessory nerve component of level II may not be necessary when performing elective ND. More research with larger numbers of patients, long-term follow-up, and meticulous tissue analysis is needed to permit conclusions as to where to draw the line in determining extent of cervical lymphadenectomy.
II 区颈淋巴结清扫术用于清除转移性疾病，涉及与颈内静脉上三分之一及相邻副神经（SAN）相关的淋巴结。保守性颈清扫术（ND）保留这些结构，但需要操作副神经以清除位于 II 区后上方的组织。将清扫范围限制在副神经前方的淋巴结组可能会减少手术时间并限制对其的损伤，同时又不影响清除有癌症累及风险的淋巴结。
对在两家不同机构接受颈淋巴结清扫术的 71 例头颈部鳞状细胞癌患者进行前瞻性评估。对 102 份颈清扫标本进行组织学分析，以确定存在的淋巴结数量和有癌症累及的淋巴结数量。手术时，将 II 区分分为副神经上部分（IIa）和副神经前方部分（IIb）。根据原发部位癌症的特征以及其他区域的淋巴结累及情况，分析 II 区的淋巴结累及情况。
颈清扫术最常用于口腔癌（n = 33），其次是喉癌（n = 17）、口咽癌（n = 7）、面部皮肤癌（n = 4）、原发灶不明（n = 4）和其他部位（n = 6）。80 例为选择性颈清扫术，22 例为根治性或改良根治性颈清扫术。颈部标本的病理分期最常见为 N0（n = 61），其次是 N1（n = 17）、N2（n = 11）和 N3（n = 11）。两份标本的数据不明确。IIb 区平均有 6.9 个淋巴结，IIa 部分平均有 4.2 个淋巴结。在 39 例淋巴结阳性标本中，有 31 例（79%）II 区存在转移性疾病。IIa 区有 4 例癌症累及，所有这些病例术前分期均为 N2 或更高。
在进行选择性颈清扫术时，可能无需额外花费时间和承担与 II 区副神经上部分清扫相关的并发症。需要进行更多涉及大量患者、长期随访和细致组织分析的研究，以便就确定颈淋巴结清扫范围的界限得出结论。
