Role of Elective Neck Dissection in Early Stage Lip Cancers

Abstract

Objective: To date, the management of the neck in early stage lower lip cancers remains controversial. The aim of this study is to investigate if prophylactic neck dissection is necessary in early stage lower lip cancers. Methods:Charts of 11 patients who underwent surgery of the primary site and neck because of T1-2N0 lower lip cancer between 1997 and 2011 were retrospectively examined. Clinical stages, surgeries, histopatological examination results, and loco-regional recurrences were evaluated. Results:Of the 11 patients, 10 were male (90.9%) and 1 was female (9.09%). The follow-up time of these patients was between 24-168 months (mean, 56.6 months). There were 5 patients with clinically diagnosed T1N0 tumors and 6 patients with clinically diagnosed T2N0 tumors. Suprahyoid neck dissection was performed in 4/5 T1N0 patients and supraomohyoid neck dissection was performed in the remaining 1 patient. For T2N0 tumors, 4 suprahyoid, 1 supraomohyoid, and 1 comprehensive neck dissection was performed. Histopathological examination revealed no occult metastasis in any of the patients. In 1 patient who had lower lip resection and suprahyoid neck dissection for T1N0 lower lip cancer, a contralateral neck metastasis was detected 22 months postsurgery, and a comprehensive neck dissection was performed. Conclusion:Our results show that in patients with T1N0 lower lip tumors, neck dissection may not be necessary; however, close follow-up is mandatory. Further researches with larger series dividing T2N0 tumors into subgroups for tumor size and thickness are necessary to determine neck treatment in these tumors. Keywords

Is Prophylactic Neck Dissection a “Must” in Early-stage Lip Cancer?

“…13 Similarly, in a study by Olgun et al, no LN metastasis was determined in any T1-T2 N0 LC cases. 23 In one of the largest series, Varthanian et al performed elective ND in 107 of 617 LC patients and found LN metastasis at the rate of 4.3% in T1-T2 N0 tumors, although this percentage increased in tumors that involved the oral commissure (15.4%) and in T3-T4 tumors (23.3%). 17 The United Kingdom Oral Cavity and Lip Cancer National Multidisciplinary Guidelines also recommend no ND if there is no clinically detectable LN involvement.…”

Our clinical approach to lip cancer; surgery and reconstruction principles

“…T1 tümörlerde okült metastaz riskinin düşük olması bu hastalarda elektif boyun disseksiyon yapmak yerine bekle gör yaklaşımının uygulanabileceğini de göstermektedir (17) . Buna karşın elektif boyun diseksiyonu şeklindeki servikal lenfadenektomi, oral kanserlerin çoğunluğunda terapötik boyun diseksiyonuna kıyasla iyileşmiş genel ve hastalıksız sağkalımı sağ-larken, son kanıtlar kalınlık olarak 4 mm'den küçük tümörler için bile avantajlar ortaya koymaktadır (18) .…”

“…Califona ve ark. (22) Klinik N+ hastalara supraomohiyoid veya bölge 4 ve 5'i içeren genişletilmiş boyun diseksiyonu önermişlerdir (23,24) . Dudak kanserleri en sık olarak submandibüler ve submental lenf nodlarına metastaz yaptığından N0 hastalara yapılacak boyun diseksiyonu en azından supraomohyoid boyun disseksiyonu olması gerektiği konusunda görüşler artmaktadır (20) .…”

Contribution of Open Mouth Technique in ¹⁸F-FDG PET/CT Imaging in Patients with Malignant Lip Neoplasm

“…The probability of cervical lymph node spread during diagnosis is between 2 and 16% in lower lip cancers ( 8 ). The gold standard treatment is neck dissection and resection of the primary tumor in the presence of lymph node metastasis ( 9 ). Accurate localization of a malignant neoplasm and early detection of cervical lymph node metastases play a critical roles in the management and survival of patients with this disease.…”