Is elective neck dissection needed in squamous cell carcinoma of maxilla?

Abstract

ObjectivesTo define the risk of occult cervical metastasis of maxillary squamous cell carcinoma (SCC) and the therapeutic value of elective neck dissection (END) in survival of clinically negative neck node (cN0) patients.Materials and MethodsSixty-seven patients with maxillary SCC and cN0 neck were analyzed retrospectively, including 35 patients with maxillary gingiva and 32 patients with maxillary sinus.ResultsOf 67 patients, 10 patients (14.9%) had occult cervical metastasis. The incidence of occult cervical metastasis of maxillary gingival SCC was higher than that of maxillary sinus SCC (17.1% and 12.5%, respectively). The 5-year overall survival rate was 51.9% for the END group and 74.0% for the non-END group. The success rate of treatment for regional recurrence was high at 71.4%, whereas that for local or locoregional recurrence was low (33.3% and 0%, respectively).ConclusionThe incidence of occult cervical metastasis of maxillary SCC was not high enough to recommend END. For survival of cN0 patients, local control of the primary tumor is more important than modality of neck management. Observation of cN0 neck is recommended when early detection of regional recurrence is possible irrespective of the site or T stage. The key enabler of early detection is patient education with periodic follow-up.

Should an elective neck dissection be performed for maxillary sinus squamous cell carcinoma?

“…Park et al conducted a retrospective analysis of 67 patients with N0 maxillary SCC; though in this cohort (Table ); the primary site was classified as either the maxillary sinus (N = 35) or the maxillary gingiva (N = 32). Within the entire cohort, 9/67 (13.4%) underwent END at the time of primary surgical resection and 58/67 (86.6%) were treated without END.…”

“…Recommendations were made using four retrospective cohort studies and one review (Level 3 evidence).…”

Importance of elective neck dissection in cN0 maxillary squamous cell carcinoma

“…We read with interest, in the online issue of Journal of the Korean Association of Oral and Maxillofacial Surgeons , the recently published, original article by Park et al 1 titled “Is elective neck dissection needed in squamous cell carcinoma of maxilla?” This article was well written and provided a great deal of information regarding the incidence of occult cervical metastasis (OCM) of clinically node-negative neck (cN0) in maxillary squamous cell carcinoma (MSCC). However, we would like to suggest a few additional items based on the authors' clinical experiences and recently updated articles.…”

“…In their article, Park et al 1 concluded that the incidence of OCM of MSCC was not high enough to recommend elective neck dissection (END). For survival of cN0 patients, local control of the primary tumor is more important than the modality of neck management.…”

“…First, Park et al 1 concluded that the incidence of OCM in MSCC is not high enough to recommend END, showing an incidence of 14.9% (10/67). However, an arithmetic proportion of 14.7% is not ignorable.…”