Elective radical neck dissection in epidermoid cancer of the head and neck: a retrospective analysis of 853 cases of mouth, pharynx, and larynx cancer

Article Abstract:

The lymphatic system provides a route for the spread of cancer cells. In most cases, cancer cells may be found within the lymph nodes near the primary cancer before spread to distant parts of the body is observed. For some cancers, it has become common to engage in radical dissection of the lymph nodes to short-circuit possible spread. For other cancers, lymph node dissection is performed only if evidence of lymph node spread is present. One of the cancers for which it is common to dissect lymph nodes is cancer of the head and neck. Since the radical neck dissection of lymph nodes is associated with significant morbidity, it is important to know if the operation is achieving its goal. At the same time, it is also important to know what risks would be incurred if the operation were performed less often. To determine the relative advantages conferred upon head and neck cancer patients by radical neck dissection, a review of 853 patients was conducted. Of the patients who had no evidence of lymph node involvement at the time of surgery for the primary tumor, 99 underwent elective radical neck dissection. (A further 95 had radical neck dissection at a future date after developing signs of lymph node involvement.) Of the 99 patients, 57 were completely negative while 42 had microscopically visible lymph node involvement. Disease-free survival was highest, at 77 percent, among the patients with negative nodes, as would be expected. However, among the patients with positive nodes, the survival was 56 percent for those with elective radical neck dissection, 49 percent for those whose dissection was delayed until clinical evidence of node involvement appeared, and 47 percent for those who had evidence of node involvement at the time of the initial surgery. The results indicate that elective radical neck dissection in the absence of clinical signs provides only a small benefit. A wait-and-see approach may be most advantageous in such cases, as only a minority of those without signs are likely to have microscopic metastases. The authors suggest, however, that elective radical neck dissection might be used in cases where the patient may be unable or unwilling to reliably return for follow-up examinations. (Consumer Summary produced by Reliance Medical Information, Inc.)

Lymph nodes, Lymph node excision

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Initial failure of surgical exploration in patients with primary hyperparathyroidism

Article Abstract:

Surgical exploration of the parathyroid area may be performed if primary hyperparathyroidism is suspected. Hyperparathyroidism, an abnormal endocrine condition, is characterized by excessive activity of any one of the four parathyroid glands, which causes increased resorption (loss) of calcium from the bones and increased absorption of calcium by the kidneys and gastrointestinal system. Parathyroid exploration is highly successful. When failure does occur (rate of 3 to 8 percent), reoperations may be difficult because of scarring and changed anatomy. The success rate of reoperation is lower than that of the initial procedure. A study was undertaken of 892 patients who underwent neck exploration for hyperparathyroidism in an attempt to determine the incidence and causes of failure. There were 27 patients (3 percent) who either continued to have elevated blood calcium levels or developed this abnormal laboratory finding within six months of surgery. Five of these patients had initially undergone removal of an adenoma (a glandular tumor), and of these, three had additional adenomas removed on reoperation. The other two patients had hyperplasia of the parathyroid and underwent partial removal of the gland. Twenty-two patients had no evidence of gland enlargement. Six patients had spontaneous return to normal calcium levels and seven patients had reoperation, with six being successful. Two patients had a distant cancer, and seven patients refused reoperation. This study confirms the high success rate of this procedure (97 percent). Proper preoperative diagnosis is essential. Diagnosis is based on elevation of serum calcium and high parathyroid hormone levels, often seen with high chloride and low phosphate levels. It is recommended that all four parathyroid glands be explored, and all abnormal glands should be removed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hyperparathyroidism, Parathyroid glands, Parathyroidectomy

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Thirty-year experience with 457 radical neck dissections in cancer of the mouth, pharynx, and larynx

Article Abstract:

Head and neck cancer is often treated by radical neck dissection (RND), an effective, but often disfiguring, surgical procedure that removes cancerous tissue to minimize its local spread. To determine the effectiveness of RND for the control and management of mouth, larynx and pharynx cancer (which have similar histology and biological behavior), a retrospective analysis of the complete medical records of 390 RND patients was performed. The patient population ranged in age from 22 to 96 years (average age was 61 years) and was made up of 269 males and 121 females. Only six patients were nonsmokers. Follow-up ranged from three to 10 years. No significant difference was observed in metastases (spread of cancer to distant sites in the body) or recurrence of the disease between the 3- and 10-year observations, therefore it is concluded that a three-year period of follow-up is adequate for reporting on the efficacy of treatment for cancers of these types. It appears that RND is useful in controlling head and neck cancer. The overall rate of disease-free survival at three years was 53 percent (the rate varied from 29 to 68 percent depending on the stage of the cancer at surgery). The most significant factors affecting long-term survival in this study were primary tumor size, how involved the lymph nodes were, and recurrence. It is noted that recurrences were unaffected by radiotherapy given either before or after surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Radical neck dissection

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