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Supraomohyoid Neck Dissection in the Treatment of Head and Neck Tumors: Survival Results in 212 Cases

Supraomohyoid Neck Dissection in the Treatment of Head and Neck Tumors: Survival Results in 212... Abstract Elective supraomohyoid neck dissection is considered part of standard treatment of oral and oropharyngeal cancer in most institutions, but its role in the treatment of clinically positive neck cancer remains a subject of controversy. The main object of this study is to report the results of 212 consecutive patients who underwent supraomohyoid neck dissections from 1954 to 1990. Most patients had squamous cell carcinoma of the oral cavity. Eighty-six patients (40.6%) had histologically positive lymph nodes in the surgical specimen (sensitivity, 0.55; specificity, 0.53). At the study closing date there were 58.8% actuarial 10-year overall survival rates. Forty-five patients (21.2%) had 50 tumor recurrences (32 local, 13 regional, five distant), and in 40 patients (18.8%) a second primary tumor was diagnosed. A multivariate regression technique based on Cox's proportional hazards model was used, and age (65 years or younger vs older than 65 years) represented the variable with the highest predictive strength with respect to overall survival (relative risk, 2.3). Tumor site, sex, and histologically proved metastasis were also associated with overall survival rates. The same variables were also related to the risk of recurrence. In conclusion, the death rate is mainly related to the control of the primary site tumor and the occurrence of a second primary tumor rather than to neck recurrences. It confirms that supraomohyoid neck dissection is an adequate elective procedure and possibly sufficient in the treatment of a selected group of patients with lip cancer with positive nodes at level 1. (Arch Otolaryngol Head Neck Surg. 1993;119:958-963) References 1. Cachin Y. Les modalites et la valeur pronostique de l'envahissement ganglionnaire cervical dans les carcinomes des voies aero-digestives superieures . La Vie Med Can Fr. 1972;1:46-58. 2. Carter RL, Barr LC, O'Brien CJ, Soo KC, Shaw HJ. Transcapsular spread of metastatic squamous cell carcinoma from cervical lymph nodes . Am J Surg. 1985;150:495-499.Crossref 3. Kalnins IK, Leonard AG, Sako K, Razack MS, Shedd DP. Correlation between prognosis and degree of lymph node involvement in carcinoma of the oral cavity . Am J Surg. 1977;134:450-454.Crossref 4. Shah JP, Strong EW, Spiro RH, Vikran B. Neck dissection: current status and future possibilities . Clin Bull. 1981;11:25-33. 5. Grandi C, Alloisio M, Moglia D, et al. Prognostic significance of lymphatic spread in head and neck carcinomas: therapeutic implications . Head Neck. 1985;8: 67-73.Crossref 6. Crile G. Excision of cancer of the head and neck with special reference to the plan of dissection based on 132 operations . JAMA . 1906;47:1780-1786.Crossref 7. DeSanto LW, Beahrs OH. Modified and complete neck dissection in the treatment of squamous cell carcinoma of the head and neck . Surg Gynecol Obstet . 1988;167:259-269. 8. Martin H, DelValle B, Ehrlich H, Cahan WG. Neck dissection . Cancer . 1951;4: 441-499.Crossref 9. Ali S, Tiwari RM, Snow GB. False-positive and false-negative neck nodes . Head Neck. 1985;8:78-82.Crossref 10. Friedman M, Mafee MF, Pacella BL Jr, Strorigl TL, Dew LL, Toriumi DM. Rationale for elective neck dissection in 1990 . Laryngoscope . 1990;100:54-59. 11. Spiro RH, Strong EW. Epidermoid carcinoma of the oral cavity and oropharynx . Arch Surg. 1973;107:382-384.Crossref 12. Ogura JH, Biller HF, Wette R. Elective neck dissection for pharyngeal and laryngeal cancers: an evaluation . Ann Otol Rhinol Laryngol. 1971;80:646-651. 13. Razack MS, Sako K, Baffi R, Patel J. Simultaneous bilateral neck dissection . J Surg Oncol. 1980;15:387-392.Crossref 14. Byers RM. Modified neck dissection: a study of 967 cases from 1970 to 1980 . Am J Surg. 1985;150:414-421.Crossref 15. Byers RM, Wolf PF, Ballantyne AJ. Rationale for elective modified neck dissection . Head Neck. 1988;10:160-167.Crossref 16. Deutsch EC, Skolnik EM, Friedman M, Hill JH, Sharer K. The conservation neck dissection . Laryngoscope . 1985;95:561-565.Crossref 17. Medina J, Byers RM. Supraomohyoid neck dissection: rationale, indications, and surgical technique . Head Neck. 1989;11:111-122.Crossref 18. Ballantyne AJ. Neck dissections for cancer . Curr Probl Cancer. 1985;9:3-34.Crossref 19. Spiro JD, Spiro RH, Shah JP, Sessions RB, Strong EW. Critical assessment of supraomohyoid neck dissection . Am J Surg. 1988;156:286-289.Crossref 20. Galen RS, Gambino SR. Beyond Normality: The Predictive Value and Efficiency of Medical Diagnosis . New York, NY: John Wiley & Sons Inc; 1975. 21. Campos-Filho N, Franco EL. Microcomputer-assisted uninvasive survival data analysis using Kaplan-Meier life table estimators . Comput Methods Programs Biomed . 1988;27:223-228.Crossref 22. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations . J Am Stat Assoc. 1958;53:457-481.Crossref 23. Cox DR. Regression models and life tables . J R Stat Soc. 1972;B34:187-220. 24. Campos-Filho N, Franco EL. Microcomputer-assisted multivariate survival data analysis using Cox's proportional hazards regression model . Comput Methods Programs Biomed . 1990;31:81-87.Crossref 25. Fletcher GH. Elective irradiation of subclinical disease in cancers of the head and neck . Cancer . 1972;29:1450-1454.Crossref 26. Marks JE, Breaux S, Smith PG, Thawley SE, Spector GG, Sessions DG. The need for elective irradiation of occult lymphatic metastases from cancers of the larynx and pyriform sinus . Head Neck. 1985;8:3-8.Crossref 27. Schuller DE, Reiches NA, Hamaker RC, et al. Analysis of disability resulting from treatment including radical neck dissection or modified neck dissection . Head Neck. 1983;6:551-558.Crossref 28. Calearo CV, Teatini G. Functional neck dissection: anatomical grounds, surgical technique, clinical observations . Ann Otol Rhinol Laryngol. 1983;92:215-221. 29. Andre S, Laccourreye H, Haguet JF. Comparison des resultats carcinologiques a long terme entre les evidements cervicaux radicaux et conservateurs . Ann Otolaryngol Chir Cervicofac. 1975;92:113-126. 30. Chu W, Strawitz JG. Results in suprahyoid, modified radical, and standard radical neck dissections for metastatic squamous cell carcinoma: recurrence and survival . Am J Surg. 1978;136:512-515.Crossref 31. Khafif RA, Gelbfish GA, Asase DK, Tepper FP, Attie JN. Modified radical neck dissection in cancer of the mouth, pharynx, and larynx . Head Neck. 1990;12:476-482.Crossref 32. Heller KS, Shah JP. Carcinoma of the lip . Am J Surg. 1979;138:600-603.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology - Head & Neck Surgery American Medical Association

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References (37)

Publisher
American Medical Association
Copyright
Copyright © 1993 American Medical Association. All Rights Reserved.
ISSN
0886-4470
eISSN
1538-361X
DOI
10.1001/archotol.1993.01880210046007
Publisher site
See Article on Publisher Site

Abstract

Abstract Elective supraomohyoid neck dissection is considered part of standard treatment of oral and oropharyngeal cancer in most institutions, but its role in the treatment of clinically positive neck cancer remains a subject of controversy. The main object of this study is to report the results of 212 consecutive patients who underwent supraomohyoid neck dissections from 1954 to 1990. Most patients had squamous cell carcinoma of the oral cavity. Eighty-six patients (40.6%) had histologically positive lymph nodes in the surgical specimen (sensitivity, 0.55; specificity, 0.53). At the study closing date there were 58.8% actuarial 10-year overall survival rates. Forty-five patients (21.2%) had 50 tumor recurrences (32 local, 13 regional, five distant), and in 40 patients (18.8%) a second primary tumor was diagnosed. A multivariate regression technique based on Cox's proportional hazards model was used, and age (65 years or younger vs older than 65 years) represented the variable with the highest predictive strength with respect to overall survival (relative risk, 2.3). Tumor site, sex, and histologically proved metastasis were also associated with overall survival rates. The same variables were also related to the risk of recurrence. In conclusion, the death rate is mainly related to the control of the primary site tumor and the occurrence of a second primary tumor rather than to neck recurrences. It confirms that supraomohyoid neck dissection is an adequate elective procedure and possibly sufficient in the treatment of a selected group of patients with lip cancer with positive nodes at level 1. (Arch Otolaryngol Head Neck Surg. 1993;119:958-963) References 1. Cachin Y. Les modalites et la valeur pronostique de l'envahissement ganglionnaire cervical dans les carcinomes des voies aero-digestives superieures . La Vie Med Can Fr. 1972;1:46-58. 2. Carter RL, Barr LC, O'Brien CJ, Soo KC, Shaw HJ. Transcapsular spread of metastatic squamous cell carcinoma from cervical lymph nodes . Am J Surg. 1985;150:495-499.Crossref 3. Kalnins IK, Leonard AG, Sako K, Razack MS, Shedd DP. Correlation between prognosis and degree of lymph node involvement in carcinoma of the oral cavity . Am J Surg. 1977;134:450-454.Crossref 4. Shah JP, Strong EW, Spiro RH, Vikran B. Neck dissection: current status and future possibilities . Clin Bull. 1981;11:25-33. 5. Grandi C, Alloisio M, Moglia D, et al. Prognostic significance of lymphatic spread in head and neck carcinomas: therapeutic implications . Head Neck. 1985;8: 67-73.Crossref 6. Crile G. Excision of cancer of the head and neck with special reference to the plan of dissection based on 132 operations . JAMA . 1906;47:1780-1786.Crossref 7. DeSanto LW, Beahrs OH. Modified and complete neck dissection in the treatment of squamous cell carcinoma of the head and neck . Surg Gynecol Obstet . 1988;167:259-269. 8. Martin H, DelValle B, Ehrlich H, Cahan WG. Neck dissection . Cancer . 1951;4: 441-499.Crossref 9. Ali S, Tiwari RM, Snow GB. False-positive and false-negative neck nodes . Head Neck. 1985;8:78-82.Crossref 10. Friedman M, Mafee MF, Pacella BL Jr, Strorigl TL, Dew LL, Toriumi DM. Rationale for elective neck dissection in 1990 . Laryngoscope . 1990;100:54-59. 11. Spiro RH, Strong EW. Epidermoid carcinoma of the oral cavity and oropharynx . Arch Surg. 1973;107:382-384.Crossref 12. Ogura JH, Biller HF, Wette R. Elective neck dissection for pharyngeal and laryngeal cancers: an evaluation . Ann Otol Rhinol Laryngol. 1971;80:646-651. 13. Razack MS, Sako K, Baffi R, Patel J. Simultaneous bilateral neck dissection . J Surg Oncol. 1980;15:387-392.Crossref 14. Byers RM. Modified neck dissection: a study of 967 cases from 1970 to 1980 . Am J Surg. 1985;150:414-421.Crossref 15. Byers RM, Wolf PF, Ballantyne AJ. Rationale for elective modified neck dissection . Head Neck. 1988;10:160-167.Crossref 16. Deutsch EC, Skolnik EM, Friedman M, Hill JH, Sharer K. The conservation neck dissection . Laryngoscope . 1985;95:561-565.Crossref 17. Medina J, Byers RM. Supraomohyoid neck dissection: rationale, indications, and surgical technique . Head Neck. 1989;11:111-122.Crossref 18. Ballantyne AJ. Neck dissections for cancer . Curr Probl Cancer. 1985;9:3-34.Crossref 19. Spiro JD, Spiro RH, Shah JP, Sessions RB, Strong EW. Critical assessment of supraomohyoid neck dissection . Am J Surg. 1988;156:286-289.Crossref 20. Galen RS, Gambino SR. Beyond Normality: The Predictive Value and Efficiency of Medical Diagnosis . New York, NY: John Wiley & Sons Inc; 1975. 21. Campos-Filho N, Franco EL. Microcomputer-assisted uninvasive survival data analysis using Kaplan-Meier life table estimators . Comput Methods Programs Biomed . 1988;27:223-228.Crossref 22. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations . J Am Stat Assoc. 1958;53:457-481.Crossref 23. Cox DR. Regression models and life tables . J R Stat Soc. 1972;B34:187-220. 24. Campos-Filho N, Franco EL. Microcomputer-assisted multivariate survival data analysis using Cox's proportional hazards regression model . Comput Methods Programs Biomed . 1990;31:81-87.Crossref 25. Fletcher GH. Elective irradiation of subclinical disease in cancers of the head and neck . Cancer . 1972;29:1450-1454.Crossref 26. Marks JE, Breaux S, Smith PG, Thawley SE, Spector GG, Sessions DG. The need for elective irradiation of occult lymphatic metastases from cancers of the larynx and pyriform sinus . Head Neck. 1985;8:3-8.Crossref 27. Schuller DE, Reiches NA, Hamaker RC, et al. Analysis of disability resulting from treatment including radical neck dissection or modified neck dissection . Head Neck. 1983;6:551-558.Crossref 28. Calearo CV, Teatini G. Functional neck dissection: anatomical grounds, surgical technique, clinical observations . Ann Otol Rhinol Laryngol. 1983;92:215-221. 29. Andre S, Laccourreye H, Haguet JF. Comparison des resultats carcinologiques a long terme entre les evidements cervicaux radicaux et conservateurs . Ann Otolaryngol Chir Cervicofac. 1975;92:113-126. 30. Chu W, Strawitz JG. Results in suprahyoid, modified radical, and standard radical neck dissections for metastatic squamous cell carcinoma: recurrence and survival . Am J Surg. 1978;136:512-515.Crossref 31. Khafif RA, Gelbfish GA, Asase DK, Tepper FP, Attie JN. Modified radical neck dissection in cancer of the mouth, pharynx, and larynx . Head Neck. 1990;12:476-482.Crossref 32. Heller KS, Shah JP. Carcinoma of the lip . Am J Surg. 1979;138:600-603.Crossref

Journal

Archives of Otolaryngology - Head & Neck SurgeryAmerican Medical Association

Published: Sep 1, 1993

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