Clinicopathological Investigation of Selective Neck Dissection( Level I-IV )
Akira Satoh PhD, Oral Diagnosis and Medicine, Department of Oral Pathobiological Science, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan
Hironobu Hata PhD, Oral Diagnosis and Medicine, Department of Oral Pathobiological Science, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan
Masaaki Miyakoshi PhD, Oral Diagnosis and Medicine, Department of Oral Pathobiological Science, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan
Kazuhito Yoshikawa PhD, Oral Diagnosis and Medicine, Department of Oral Pathobiological Science, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan
Jun Sato PhD, Oral Diagnosis and Medicine, Department of Oral Pathobiological Science, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan
Yoshimasa Kitagawa PhD, Oral Diagnosis and Medicine, Department of Oral Pathobiological Science, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan
We carried out selective neck dissection (level I ~ IV) with preservation of the sternocleidmastoid muscle, internal jugular vein and accessory nerve. In order to validate the rationale of omitting level V dissection, we clinicopathologically examined 26 patients with oral cancer who received selective neck dissection from January 2009 to March 2013 in Oral Medicine, Hokkaido University Hospital. There were 20 male and 6 female patients with a median age of 65 years (range 40-82). The selective neck dissection was done prophylactically in 7 patients and therapeutically in 19 patients. In therapeutic selective neck dissection, the indication is 1 or 2 metastatic lymph nodes in level I ~ II on our institution. We analysed histopathological mode of cervical lymph node metastasis and clinical courses in these patients.
Histopathologically, pN0 was found in 9 patients, pN1 in 9 patients, pN2a in 2 patients, and pN2b in 6 patients. Metastatic lymph nodes (LNs) were located in level I in 10 patients, level II in 5, and level IV in 2. 5 LNs were found in 1 patient, 3 LNs in 1, 2 LNs in 4, and 1 LN in 11. Extranodular metastatic lesions were found in level I in 8 patients and level II in 1. The clinical courses after selective neck dissection were local recurrence in 2 patients, contralaterally secondary cervical lymph node metastasis in 1, submandibular recurrence in 1, but neck recurrence in level V didn’t appear in any patients.
Our results suggest that it is possible to omit level V dissection in the case of clinically 1 or 2 metastatic lymph nodes in level I ~ II.
References
1) Akira Satoh, Kanchu Tei, et al.: Clinical study on the cases for neck dissection in oral squamous cell carcinoma-The relationship between mode of cervical lymph node metastasis and prognosis-. J Jpn Soc Oral Tumor 8(4): 273-281, 1996.
2) Parikh DG, ChhedaYP, et al: Significance of level v lymph node dissection in clinically node positive oral cavity squamous cell carcinoma and evaluation of potential risk factor for level v lymph node metastasis. Indian J Surg Oncol 4(3): 275-279, 2013.
