Abstract
The present study was undertaken to determine the pattern and incidence of predictable lymphatic spread and skip metastasis in oral cancer and analyze the prognostic implications of different therapeutic modalities in the neck metastases. The study includes 81 patients with squamous cell carcinoma of oral cavity with T1-2N0M0 and T1-3N1-3M0 who were admitted to the Department of ENT and Head and Neck Surgery, SMS Medical College and Hospital, Jaipur, from June 2006 to May 2008. After complete diagnostic evaluation (imaging, FNAC), all these patients were operated (wide primary excision with SOHND/Extended SOHND/MRD-I) and followed up periodically till date. Occult metastasis was found in 26% of the patients. Level I, II, III was most commonly involved. We did not find any metastasis or recurrence at level IV in N0 cases. Involvement of level IV node in N0 and N+ neck were 0 and 9%, respectively. We did not find any “skip metastasis” at level IV in oral cancers. We concluded that SOHND for N0 and MRND type I for N+ neck for oral cancers is an appropriate treatment.
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Parkin SM, Laara E, Muir CS (1988) Estimates of the worldwide frequency of sixteen major cancer in 1980. Int J Cancer 41(2):184–197
Nair UJ, Friesen M, Richard I et al (1990) Effect of lime composition on formation of reactive oxygen species from the areca nut extract in vitro. Carcinogenesis 11:2145–2148
Kligerman J, Lima RA, Soares JR et al (1994) Supraomohyoid neck dissection in the treatment of T1/T2 squamous cell carcinoma of oral cavity. Am J Surg 168:391–394
Dias FL, Kligerman J, Matos de SA et al (2001) Elective neck dissection versus observation in stage I squamous cell carcinomas of the tongue and floor of the mouth. Otolaryngol Head Neck Surg 125:23–29
Shah JP (1990) Pattern of cervical lymph node metastasis from squamous carcinomas of the upper aerodigestive tract. Am J Surg 160:405–409
Lindberg R (1972) Distribution of cervical lymph node metastasis from squamous cell carcinoma of upper respiratory and digestive tract. Cancer 29:1446–1449
Teichgraeber JF, Clairmont AA (1984) The incidence of occult metastasis for cancer of the oral tongue and floor of the mouth—treatment rationale. Head Neck Surg 7:15–21
Byers RM, Wolf PF, Ballantyne AJ (1988) Rational for elective modified neck dissection. Head Neck Surg 10:160–167
Dias FL, Lima RA, Kligerman J, Farias TP, Soares JRN, Manfro G (2006) Relevance of skip metastases for squamous cell carcinoma of the oral tongue and the floor of the mouth. Otolaryngol Head Neck Surg 134:460–465
Byers RM, Weber RS, Andrews T et al (1997) Frequency and therapeutic implications of “skip metastases” in the neck from squamous carcinoma of the oral tongue. Head Neck 19:14–19
Ferlito A, Mannara GM, Rinaldo A, Pliti M, Robiony M et al (2000) Is extended selective supraomohyoid neck dissection indicated for treatment of oral cancer with clinically negative neck. Acta Otolaryngol 120(7):792–795
Martin H, Del Valle B, Ehrlich HE et al (1951) Neck dissection. Cancer 4:441–499
Bocca E, Pignataro O, Oldinic et al (1984) Functional neck dissection—an evaluation and review of 843 cases. Laryngoscope 94:942–945
Gavilan J, Gavilan C, Herranz J (1992) Functional neck dissection—three decades of controversy. Ann Otol Rhinol Laryngol 101:339–341
Brazilian Head and Neck Cancer Study Group (1998) Results of a prospective trial on elective modified radical classical versus supraomohyoid neck dissection in the management of oral squamous carcinoma. Am J Surg 176:422–427
Pitman KT, Johnson JT, Myers EN (1997) Effectiveness of selective neck dissection for management of the clinically negative neck. Arch Otolaryngol Head Neck Surg 123:917–922
Robbins KT, Clayman G, Levine PA et al (2002) Neck dissection classification update. Arch Otolaryngol Head Neck Surg 128:751–758
Lydiatt DD, Robbins KT, Byers RM et al (1993) Treatment of stage I and II oral tongue cancer. Head Neck 158:308–312
Khafif A, Lopez-Garza JR, Medina JE (2001) Is dissection of level IV necessary in patients with TI-T3 N0 tongue cancer? Laryngoscope 111:1088–1090
Kowalski LP, Bagietto R, Lara JRL et al (2000) Prognostic significance of the distribution of neck node metastasis from oral carcinoma. Head Neck 22:207–214
Li XM, Wei WI, Goo XF et al (1996) Cervical lymph node metastatic patterns of squamous cell carcinomas in the upper aerodigestive tract. J Laryngol Otol 110:941–973
Beenken SW, Kronfiras H, Maddox WA et al (1999) T1 and T2 squamous cell carcinoma of the oral tongue—prognostic factors and the role of elective lymph node dissection. Head Neck 21:124–130
Woolgar A (1999) Histological distribution of cervical lymph node metastases from intraoral-oropharyngeal squamous cell carcinomas. Br J Oral Maxillofac Surg 37:175–180
Kaya S, Yilmaz T, Gursel B et al (2001) The value of elective neck dissection in treatment of cancer of the tongue. Am J Otolaryngol 22:59–64
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Authors do not have any financial relationship with the organization that sponsored the research. The authors declare that they have no conflict of interest.
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Mishra, P., Sharma, A.K. A 3-year study of supraomohyoid neck dissection and modified radical neck dissection type I in oral cancer: with special reference to involvement of level IV node metastasis. Eur Arch Otorhinolaryngol 267, 933–938 (2010). https://doi.org/10.1007/s00405-009-1155-9
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DOI: https://doi.org/10.1007/s00405-009-1155-9