Supraomohyoid neck dissection in the management of oral squamous cell carcinoma: special consideration for skip metastases at level IV or V.

PURPOSE: The aim of this study was to evaluate the therapeutic safety and prognosis of supraomohyoid neck dissections for oral squamous cell carcinoma, with a special focus on the risk of skip metastases in level IV or V. MATERIALS AND METHODS: A retrospective study was conducted of 637 patients with oral squamous cell carcinoma who were admitted to the department of oral and maxillofacial surgery from September 1995 through July 2010. After completing a diagnostic evaluation, all patients underwent surgery (wide primary excision with supraomohyoid neck dissection, extended supraomohyoid neck dissection, or modified radical or radical neck dissection) and were followed periodically. RESULTS: Levels I, II, and III were the most common sites of occult metastasis. Skip metastases alone at level IV or V and any neck recurrence at level IV or V were not found. Three-year neck recurrence-free survival and disease-specific survival were not significantly different among the patients who underwent supraomohyoid neck dissection, extended supraomohyoid neck dissection, or modified radical or radical neck dissection owing to cN0 to cN(+) disease. CONCLUSIONS: The rate of skip metastasis at level IV or V is very rare and is very difficult to diagnose accurately. The results of this retrospective study show that supraomohyoid neck dissection for oral squamous cell carcinoma is an appropriate treatment.

Prognostic factors of squamous cell carcinoma of the buccal mucosa: a retrospective study of 168 cases in North China.

PURPOSE: Buccal mucosa squamous cell carcinoma (BSCC) is considered a rare and aggressive malignancy that has a high rate of locoregional recurrence. The aim of this study was to analyze the outcome of surgical therapy as a treatment for BSCC in a North Chinese population over a period of 14 years. MATERIALS AND METHODS: A retrospective study was performed by reviewing the records and pathologies of 168 patients with BSCC who were treated at the Department of Oral and Maxillofacial Surgery, Stomatological Hospital, Peking University, from June 1999 to September 2013. RESULTS: The rates of local, regional, and locoregional recurrence were 47.3%, 13.5%, and 6.8%, respectively. The neck metastasis rate in patients classified as having cN0 was 28.4%, and the occult metastasis rate in patients with BSCC stages T2 to T4 was higher than 15%. Neck metastases were most common at levels I and II. The 3-year disease-free survival, overall survival, and disease-specific survival rates were 60.6%, 74.6%, and 78.0%, respectively. Gender, T stage, pathologic node status, and pathologic grade were significant factors in determining disease-specific survival. However, only pathologic node status (P = .002) was an independent predictive factor of 3-year disease-specific survival. CONCLUSIONS: Buccal carcinoma is an aggressive disease with high rates of local and regional recurrence. In seeking to offer better prognoses and quality of life, extensive resection of the primary tumor, supraomohyoid neck dissection, and preferred free flap reconstruction are the therapies that have been recommended and used in the authors' hospital during the past 10 years.

Neck recurrence of oral squamous cell carcinoma in unusual sites: Retrospective study of 1658 cases.

BACKGROUND: The purpose of this study was to explore the frequency and prognosis of irregular neck recurrences in the prelaryngeal, parotid, and lateral retropharyngeal regions in patients with oral squamous cell carcinoma (OSCC). METHODS: We conducted a retrospective study. RESULTS: Twenty-four patients (1.4%) had irregular neck recurrences: 17 in the parotid (1.0%), 4 in the prelaryngeal (0.2%), and 3 in the lateral retropharyngeal (0.2%) regions. The 1-year/5-year overall survival rates after the N-relapse date for these areas were 40.0%/25.0%, 42.9%/20.0%, and 33.3%/0%, respectively. Patients with irregular neck recurrences had a poorer salvage success rate than controls (21.7% vs 68.8%, respectively; p < .001) as well as a significantly lower 5-year disease-specific survival (23.8% vs 60.8%, respectively; p < .001). CONCLUSION: Patients with OSCC with irregular neck recurrences were extremely rare and had poor prognoses. The management of irregular metastases in patients with OSCC remains challenging for surgeons. Further study will be worthwhile to evaluate the best diagnostic and management strategies for unusual neck recurrences of OSCC. © 2015 Wiley Periodicals, Inc. Head Neck 38: E680-E686, 2016.

Risk factors and treatment of contralateral neck recurrence for unilateral oral squamous cell carcinoma: a retrospective study of 1482 cases.

BACKGROUND: The aim of this study was to describe risk factors of contralateral neck recurrence (CLNR) and to identify its high-risk population after treatment for unilateral oral squamous cell carcinoma. METHODS: Between June 1991 and June 2012, a total of 1482 eligible patients who were treated with radical surgery with or without adjuvant therapy were retrospectively reviewed. RESULTS: The outcome assessment parameters were the rate of 5-year CLNR and the rate of disease-specific survival (DSS). In the entire study cohort, the 5-year CLNR rate was 4.1%. In a multivariate analysis, only extracapsular spread (ECS) status (hazard ratio [HR]: 12.978, 95% confidence interval [CI]: 1.328-126.829, P=0.028) was an independent risk factor for 5-year CLNR. In addition, 5-year CLNR (HR: 36.410, 95% CI: 7.093-186.914, P<0.001), T stage (HR: 3.475, 95% CI: 1.151-10.488, P=0.027) and growth pattern (HR: 4.831, 95% CI: 1.776-13.140, P=0.002) were independent risk factors for 5-year DSS. Patients with at least two risk factors were identified as a high-risk population for CLNR; these patients also had a poor prognosis. Elective contralateral neck dissection (ND) plus concurrent chemoradiotherapy (CCRT) can improve the 5-year DSS in these high-risk patients, but it does not decrease the 5-year CLNR rate. CONCLUSION: For low- and moderate-risk patients, contralateral neck observation should be considered sufficient if strict compliance with a cancer surveillance protocol is followed. However, whether high-risk patients benefit from contralateral ND plus adjuvant CCRT can only be answered in a prospective trial.

Supraomohyoid neck dissection and modified radical neck dissection for clinically node-negative oral squamous cell carcinoma: a prospective study of prognosis, complications and quality of life.

BACKGROUND: To assess the prognosis and morbidity between supraomohyoid neck dissection (SOND) and modified radical neck dissection (MRND) for oral squamous cell carcinoma (OSCC) in patients with a clinically node-negative neck (cN0). PATIENTS AND METHODS: This prospective randomized study began in June 1999, and patient accrual concluded in May 2010. The cN0 neck was confirmed on clinical palpation by senior doctors. Ultimately, there were 322 patients recruited into the study. RESULTS: Patient demographics were well balanced between the two groups. There were 10 patients in the SOND group and 21 patients in the MRND group who developed nodal recurrence without associated local recurrence or distant metastasis. The 3-year neck control rate (NCR) rate was 92.6% for the SOND group and 87.5% for the MRND group (in favor of SOND, P = 0.108). There was no significant difference between the SOND group and the MRND group in the 3-year disease-specific survival (DSS) rate (79.0% vs. 76.9%, P = 0.659). Importantly, there were significantly fewer complications in the SOND group compared with the MRND group (13.0% vs. 21.9%, P = 0.040). The disease-free survivors in the SOND group also reported better pain relief (P = 0.013) and shoulder function (P < 0.001) than those in the MRND group one year after treatment. CONCLUSIONS: We recommend SOND as a priority treatment for cN0 OSCC patients.