Background
Terminology for neck dissection is quite complicated because a large number of nonradical neck dissections were created by different surgeons, each of whom named their operational method ...in their own words in an attempt to preserve functions that were usually lost by radical neck dissection. This complication is still causing serious confusion among head and neck surgeons throughout the world, although there have been many proposals for standardization.
Methods
Japan Neck Dissection Study Group created in 2005 and updated in 2009 a new classification and nomenclature system that is easy to understand, compatible with Japanese classifications of other carcinomas, and easily interchangeable with other neck dissection terminology proposals.
Results
Based on the Classification of Regional Lymph Nodes in Japan, published by the Japan Society of Clinical Oncology, our new system divides cervical lymph nodes into four basic regions and other regions. Each of the four basic regions is further divided into several subregions. Each region, subregion, or principal nonlymphatic structure has its own symbol consisting of one alphabetical letter, two alphabetical letters, or one alphabetical letter plus one numeral. Each neck dissection operation is designated by a combination of these symbols. Neck dissections are classified into two groups, total neck dissection and selective neck dissection, according to the extent of resection of the cervical lymph nodes.
Conclusion
We simply hope that this new system will contribute to resolving the confusion over the terminology used for neck dissection, not only in Japan but throughout the world.
Background
We performed a multicenter longitudinal study using our neck dissection questionnaire (NDQ) and arm abduction test (AAT) to assess the impact of rehabilitation and surgical modification on ...postoperative quality of life (QOL).
Methods
Patients who had undergone neck dissection for the treatment of head and neck cancer answered the NDQ and completed the AAT 1, 3, 6, and 12 months after surgery. All patients enrolled in this study underwent a rehabilitation program designed for neck dissection. The obtained data were statistically analyzed according to the types of neck dissection and compared with the data of patients who had undergone neck dissection but not rehabilitation.
Results
A total of 224 patients were enrolled in this study. Our findings revealed that resection of the sternocleidomastoid muscle (SCM) and spinal accessory nerve (SAN) resulted in shoulder drop. Lowering the dissection level and preservation of the SAN and SCM significantly reduced various sensory symptoms of the neck, such as stiffness, pain, numbness, and constriction, and improved shoulder function. Postoperative rehabilitation had a significant effect on arm abduction ability, particularly when the SCM and SAN were resected.
Conclusions
The study demonstrated that rehabilitation, in addition to modifications to radical neck dissection, contributed to the improvement of postoperative QOL after neck dissection.
Abstract Objective In cases of differentiated thyroid carcinoma, the presence or absence of invasion into the circumferential organs is an important prognostic factor. Surgical procedures include ...circular resection of the trachea with end-to-end anastomosis and window resection with secondary closure. We have used window resection with secondary closure since 1993, and herein retrospectively analyze the treatment outcomes for this surgical procedure in order to determine the indications for procedure selection. Methods Subjects comprised 41 cases of invasion by differentiated thyroid carcinoma into the trachea, for which surgery was performed at the Department of Head and Neck Surgery of the National Cancer Center Hospital East from 1993 to 2007. The mean age was 65.7 ± 7.9 years, and the median length of the observation period was 43 months. There were 17 cases (41.4%) cases of secondary relapse. Results The 5-year and 10-year overall survival rates for this surgical procedure were 78.9% and 74.5%, respectively, while the 5-year and 10-year local control rates were 92.4% and 73.4%, respectively. The pathological resection stump was positive in 27 cases (65.8%), but no significant differences in treatment outcome were observed between the stump-positive group and the stump-negative group. There were 26 cases in which closure of the tracheal fistula was performed by the time of observation. When the tracheal defect had a diameter equivalent to 7 rings of the trachea or less and a circumference half that of the tracheal cartilage or smaller, including partial cricoid cartilage, it was possible to perform closure with only a local flap. For larger defects, reconstruction was performed using hard tissues or materials, such as hydroxyapatite, titanium mesh, and costal cartilage. There were 2 cases that required re-window because of dyspnea after closure. Conclusion The treatment outcomes for this surgical procedure for invasive cases of differentiated thyroid carcinoma into the trachea resulted in a low rate of local recurrence and similar survival rates as described in other reports. Even for cases of resection exceeding half the circumference of the trachea, closure of the tracheal fistula can be performed using hard tissues or materials; however, in such cases, we believe that closure should be attempted progressively in a two-stage reconstruction.
Background
Because there are few exchanges of doctors and surgical techniques among leading Japanese hospitals, neck dissections in Japan have become so highly diverse that the uniformity and ...comparability of nonradical neck dissections have become questionable.
Methods
The Japan Neck Dissection Study Group (JNDSG) was organized in 2002 and includes 22 leading Japanese hospitals as members. To enhance exchanges among member hospitals and standardize nonradical neck dissections, JNDSG planned and conducted a prospective study, in which surgeons from participating hospitals were directed to observe neck dissections conducted by surgeons in other hospitals. To standardize the observation method, JNDSG created a specialized form consisting of 79 questions regarding details of neck dissection.
Results
A total of 235 patients were enrolled between February 18, 2004 and November 22, 2006. Of the 79 questions, difference among participating hospitals was confirmed in 13 details and strongly suspected in 7 details. To standardize these 20 details, JNDSG established a manual, “Standard Surgical Maneuvers for Each Detail of Neck Dissection,” based on the discussion about the optimal procedures concerning each detail. As the study proceeded from the first to the second stage, the intensity of difference among the hospitals decreased in 11 details and increased in 6 details. Because there were more details showing decreased intensity, this study was concluded to have contributed to some extent to the standardization of nonradical neck dissections in Japan.
Conclusions
Although standardization of a surgical procedure in a multi-institutional setting is a very rare undertaking, this study achieved noteworthy success.
Objective We investigated the risk factors for metastasis to retropharyngeal lymph nodes (RPLNs) and the significance of dissection of RPLNs in hypopharyngeal cancer. Metastasis to the RPLNs is an ...important prognostic factor in head and neck cancer, especially in hypopharyngeal cancer. Methods Study subjects were 129 cases who received primary treatment at nine leading medical facilities in the field of head and neck cancer management in Japan. Focusing on RPLNs, we compared prognosis in RPLN-metastasis-positive, RPLN-metastasis-negative, RPLN-dissected and RPLN-non-dissected cases. Results The 5-year survival rate for the entire study group was 41.1%. Metastasis to RPLNs occurred during the follow-up period in 13.2%. RPLN dissection was performed in 32 of the 129 cases at the time of primary treatment. In the RPLN-dissected group, the 5-year survival rate in the RPLN-metastasis-positive subgroup was 30.0%, whereas that in the RPLN-metastasis-negative subgroup was 41.2%, showing no statistically significant difference. Among 17 cases having RPLN metastasis, 30.0% in the RPLN-dissected group (n = 10) survived for 5 years versus none in the RPLN-non-dissected group (n = 7). The rate of RPLN metastasis was higher in primary hypopharyngeal cancer of the posterior wall/post-cricoid area (PC/PW) compared with that of the piriform sinus (P = 0.020). Conclusions We recommend RPLN dissection at the time primary of treatment of hypopharyngeal cancer, especially in cases with cancer at subsites PC/PW, as RPLN dissection is expected to improve prognosis. The primary subsites PC/PW are associated with a risk of RPLN metastasis.
The main goals of today's cancer surgery are radical resection and the preservation of function. A better understanding of cancer spread and advances in surgical techniques have made possible various ...function-preserving operations. Their common characteristics are a smaller extent of resection and/or preservation of nerves, vessels, or other structures. Function-preserving surgery in its broader sense also includes reconstructive surgery.
Objective We evaluated patients with small oral tongue cancer suffering from recurrence, which develops in the intervening area between the primary site and the neck. Lesions in the area around the ...cornu of the hyoid bone (‘para-hyoid’ area) often involve the hypoglossal nerve and the root of the lingual artery, resulting in treatment failure and death. Methods A 10-year retrospective chart review was conducted of 248 oral tongue cancer patients with small primary tumors (T1/2). No patients who underwent postoperative radiotherapy (PORT) were included. Results After excluding those who had local failure or developed new primary lesions, 6.3% of the patients were noted to have a para-hyoid lesion. A similar incidence was observed between the patients with and without previous neck dissection, 6.9% and 5.7%, respectively. All but one patient died due to uncontrolled neck disease. Conclusions Recurrent para-hyoid lesions could occur, irrespective of a previous neck dissection. In other words, the para-hyoid area is beyond the limits of a neck dissection. Once a para-hyoid lesion becomes clinically evident, it seems difficult to salvage. Therefore, a careful inspection of the area should be included intraoperatively in any type of neck dissection (i.e. elective or therapeutic) for patients with oral tongue cancer. This may be the key to improving the regional control rate of patients with small oral tongue cancer. We believe that some patients will benefit from more aggressive treatment of the neck, although PORT seems unnecessary for the majority of the patients with limited neck disease.
Objective The purpose of this study was to determine the role of surgical treatment and to identify factors affecting the survival of patients undergoing pulmonary resection for tumors metastatic ...from head and neck carcinomas. Methods Thirty-three patients who had undergone resection of pulmonary tumors metastatic from head and neck carcinomas, other than thyroid cancers and sarcomas of the head and neck, were reviewed. Results The operative morbidity rate was only 6%, no patients died within 30 days after resection and complete resection was achieved in 94% of patients. The overall 1- and 3-year survival rates were 76% and 43%, respectively, and the median survival time was 21 months. The factors found on univariate analysis to significantly affect survival were a disease-free interval of ≤2 years, tongue carcinoma and squamous cell carcinoma. The factor found, on multivariate analysis, to most strongly affect survival was tongue carcinoma. The most frequent pattern of initial recurrence after pulmonary resection was distant metastasis (64%). Conclusions The safety and effectiveness of surgical treatment for pulmonary tumors metastatic from head and neck carcinomas in adaptive criteria for resection are well demonstrated. The poor survival after surgical resection of pulmonary tumors metastatic from cancers of the tongue should be noted.
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