Comparison of morbidity between sentinel node biopsy and elective neck dissection for treatment of the n0 neck in patients with oral squamous cell carcinoma

“…SND: 0/7 (0%) [26] Loss of general shoulder strength -prevalence Mixed cohort: 11% [22]. SND: moderately impaired 2/29 (7%), severely impaired 2/29 (7%) [85]. SNB: 0/33 (0%) [85].…”

mentioning

confidence: 99%

Prevalence, incidence, and risk factors for shoulder and neck dysfunction after neck dissection: A systematic review

Gane

Michaleff

Cottrell

et al. 2017

European Journal of Surgical Oncology (EJSO)

116

102

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“…Furthermore, in a prospective study comparing postoperative complications and quality of life in patients with HNSCC of the oral cavity and oropharynx submitted to either SNB or END, fewer complications and improved quality of life was observed in those patients who underwent SNB [30].…”

Section: Discussionmentioning

confidence: 98%

Sentinel Lymph Node Biopsy vs. Elective Neck Dissection in Patients with T1/T2 N0 Oral Squamous Cell Carcinoma: A Matched Pair Analysis

de¹

2016

Int J Oral Craniofac Sci

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Background: The management of the clinically and radiological negative neck in patients with early squamous cell carcinoma of head and neck (HNSCC) is still controversial. As approximately 20 to 30% of these patients harbor occult neck disease, most of them is submitted to elective neck dissection with no benefit in great majority of those cases. Sentinel lymph node biopsy (SLB) is a potential method for staging of lymphatic metastasis in HNSCC and the status of the sentinel node predicts the presence of metastasis in the remainder of the nodes within the nodal basin.Objective: To evaluate the neck recurrence rate of patients with early stage (T1/T2) HNSCC of the oral cavity with clinically negative necks (cN0), in patients submitted to sentinel lymph node biopsy (SNB) or elective neck dissection (END). Methods:Clinical retrospective comparison of two patient cohorts of early stage oral cancer tested for primary tumor resection and SNB without subsequent END or primary tumor resection with END. Those comparisons were made by a matched pair analysis. Results:The current study included 52 patients with early stage oral cancer; 30 in the SNB group and 22 in the control group (END). Both SNB and END groups had similar performance regarding the recurrence rate of neck, without significant difference between both groups. Conclusion: Neck recurrence rates were similar between groups of patients in which SNB or END was performed.the gold standard approach for staging the cervical lymph nodes in patients with HNSCC.END is simultaneously a therapeutic and staging procedure that may be beneficial for patients who are subsequently found to harbor occult disease. However, these situations occurs in approximately 25% of those cases, leading to the possibility of 75% of the remains patients are being over treated [13,14].There was a prospective randomized study in the literature to compare elective ipsilateral radical neck dissection versus observation in the treatment of stage I to II oral tongue carcinoma in India [15]. Another prospective randomized study of T1-3N0M0 of mixed oral tongue and floor of mouth carcinomas was conducted in France comparing observation and elective ipsilateral radical neck dissection [16]. These 2 prospective randomized studies did not show any survival benefit of elective radical neck dissection, but it has to be noted that those papers had a limitations regarding to the number of patients included.Another prospective randomized study of selective neck dissection (levels I, II, III) versus observation for N0 neck of stage I to II oral tongue carcinoma shows that the 5-year disease-specific survival rate was 87% for the observation group and was 89% for the END group; the 2% difference was not significant [16].

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“…15 Murer et al reported lower postoperative morbidity rates and better shoulder function following a SLN biopsy in comparison to an END. 49 Hernando et al observed statistically significant increased shoulder function and reduced average scar length among patients receiving a SLN biopsy in comparison to those undergoing END; neck haematomas and orocervical communication were reported only in the END group and SLN biopsies were associated with lower rates of postoperative morbidity. 44 Alkureishi et al reported that the pathological review of a SLN or neck dissection specimen can affect the staging of a lymph node if it reveals occult or additional positive lymph nodes which might have been missed on a routine physical examination or radiographical evaluation.…”

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confidence: 99%

Sentinel Lymph Node Biopsy: A new approach in the management of head and neck cancers

Sharma¹,

Koshy²,

Grover³

et al. 2017

SQUMJ

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‫شارما‬ ‫بوشان‬ ‫جروفر,‬ ‫سونال‬ ‫كوشي,‬ ‫جورج‬ ‫شارما,‬ ‫ديبيت‬ abstract: Cervical lymph node metastasis affects the prognosis and overall survival rate of and therapeutic planning for patients with head and neck squamous cell carcinomas (HNSCCs). However, advanced diagnostic modalities still lack accuracy in detecting occult neck metastasis. A sentinel lymph node biopsy is a minimally invasive auxiliary method for assessing the presence of occult metastatic disease in a patient with a clinically negative neck. This technique increases the specificity of neck dissection and thus reduces morbidity among oral cancer patients. The removal of sentinel nodes and dissection of the levels between the primary tumour and the sentinel node or the irradiation of target nodal basins is favoured as a selective treatment approach; this technique has the potential to become the new standard of care for patients with HNSCCs. This article presents an update on clinical applications and novel developments in this field. A s opposed to primary tumours, metastasis is responsible for the high mortality rate of most cancer patients; moreover, cancer cells primarily invade the regional lymph nodes before spreading to other parts of the body. Keywords1 Genetic instability results in tumour cell heterogeneity, leading to the emergence of metastatic clones and dissemination of the cancer from the primary tumour site.2 Malignant cells metastasise due to an interaction between the host factors and tumour cells. Genes related to the extracellular matrix, adhesion, motility and protease inhibition constitute a significant part of the metastatic process. The migration and invasion of cancer cells into the lymphatic system is governed by a variety of intricate genotypic, phenotypic and microenvironmental processes. After entering the lymphatic draining channels, the tumour cells metastasise to the regional lymph nodes in the neck and form the metastatic foci.4 Macrometastases refer to lymph nodes that appear suspicious on clinical or radiographical examinations; in contrast, nodal metastases-which are not detectable by imaging methods or physical examination-indicate occult or subclinical metastasis. Hermanek microscopically differentiated occult metastases into macrometastases (metastatic deposits of >2 mm), micrometastases (metastatic deposits of <2 mm) and isolated or small clusters of tumour cells (metastatic deposits of <0.2 mm).5 Isolated tumour cells (ITCs) can also be defined as a cluster of ≤200 tumour cells visible on one histology slide; these cells can further be categorised into those detectable by light microscopy, immunohistochemistry or molecular methods.6 Chemoradiation or elective neck dissection (END) should be considered in patients

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Comparison of morbidity between sentinel node biopsy and elective neck dissection for treatment of the n0 neck in patients with oral squamous cell carcinoma

Abstract: SNB is associated with significantly less postoperative morbidity and better shoulder function than elective neck dissection. This supports our opinion that patients with nodal negative early SCC of the oral cavity should be offered SNB.

Cited by 163 publications

References 26 publications

Prevalence, incidence, and risk factors for shoulder and neck dysfunction after neck dissection: A systematic review

Prevalence, incidence, and risk factors for shoulder and neck dysfunction after neck dissection: A systematic review

Sentinel Lymph Node Biopsy vs. Elective Neck Dissection in Patients with T1/T2 N0 Oral Squamous Cell Carcinoma: A Matched Pair Analysis

Sentinel Lymph Node Biopsy: A new approach in the management of head and neck cancers

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