Significance of neck dissection in Ⅱb area in early oral squamous cell carcinoma

doi:10.19438/j.cjoms.2020.01.004

Abstract

Abstract: PURPOSE: To evaluate the clinical significance of selective cervical lymph node dissection in patients with oral squamous cell carcinoma without clinically cervical lymph node metastasis (cN0). METHODS: Between January 2012 and December 2014, 203 patients with cN0 who were treated in the Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, the average age was 59.7 (range:41-79) years, no other treatment was given before surgery. There were 127 males and 76 females. The primary sites were as followed: 101 in the tongue, 45 in the cheek, 30 in the floor of mouth, 19 in the gingiva, and 8 in other sites. According to postoperative pathological results, 203 patients were classified as T1 or T2, and all underwent primary lesion resection and supraomohyoid neck dissection (SOHND). One hundred and fifteen patients underwent Ⅱb level lymph node dissection, and the remaining 88 patients did not receive Ⅱb level lymph node dissection. The data of the two groups of patients were analyzed by independent sample t test with SPSS 22.0 software package. The analyzed indicators included incidence of complications (mainly scapular syndrome) and Ⅱb lymph node metastasis rate (mainly for the preserving Ⅱb group). Survival analysis was estimated by Kaplan-Meier method. RESULTS: In the Ⅱb level lymph node dissection group, 7(6.09%) patients were confirmed by postoperative pathology to have lymph node metastasis in the Ⅱb area. After 3 years of follow-up, 83(72.17%) patients had different degrees of scapular syndrome, and 27(32.53%) patients were relieved by rehabilitation training, but still not fully recovered. The 3-year overall survival of patients in Ⅱb level lymph node dissection group for 86.09%; in the control group, 4 patients (4.55%) developed scapular syndrome and recovered through rehabilitation after operation. The 3-year overall survival rate of the patients in the control group was 84.09%. There was no significant difference between the two groups (P>0.05). CONCLUSIONS: Patients with cN0 oral squamous cell carcinoma have a lower rate of cervical lymph node metastasis in the IIb level. Therefore, it is not necessary to excise the lymph nodes in the Ⅱb area when SOHND is performed, in order to protect the accessory nerve and its branches from damaging and improving the quality of life of the patients.

Key words: Oral squamous cell carcinoma, Supraomohyoid neck dissection, Ⅱb lymph nodes, Accessory nerve, Scapular syndrome

CLC Number:

R739.8

WU Hao, GONG Han-wen, WANG Gao-jun, TANG Qing-hua, HU Wen-ting, ZHANG Ling. Significance of neck dissection in Ⅱb area in early oral squamous cell carcinoma[J]. China Journal of Oral and Maxillofacial Surgery, 2020, 18(1): 22-27.

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