Sinan KOCATÜRK, Nurettin ÖZDEMİR, Ünsal ERKAM, Halit UZUN, Aykut BABİLA, Erkan ÖZTÜRK

Alt dudak kanserlerinde gizli lenf nodu metastazı oranları ve No boyna yaklaşım

Amaç: Bu çalıflmada alt dudak kanserli hastalardagizli lenf nodu metastazı varlığı ve N0boyunlara yaklaflım değerlendirildi. Hastalar ve Yöntemler: Alt dudakta skuamöz hücreli tümör nedeniyle ameliyat edilen ve en az üç yıltakip edilen 68 hasta çalıflmaya alındı. Hastaların tümü erkekti . Ameliyat öncesinde 15 hastada N+, 53 hastada N0boyun saptandı. Tümörün yerleflim yerine bağlı olarak tek yada iki taraflı suprahyoid boyun diseksiyonu SHBD yapıldı. Ameliyat sonrasındaki histopatolojik incelemede metastaz saptanan dokuz hastaya radikal boyun diseksiyonu uygulandı.Bulg u l a r : Ameliyat öncesinde N+olarak değerlendirilen hastaların dördünde 4/15; %26 , N0olarak değerlendirilen hastaların beflinde 5/53; %9.4 histopatolojik incelemede metastaz görüldü %13.2 . Dört hastada %6.7 , üçüncü seviyede geç metastaz geliflti. Hastaların %93’ünde boyunda hastalık bulgusu görülmedi. Son uç : Gizli metastazların saptanmasında SHBD’ninçok etkili olduğu görüldü. Uygulamaya bağlı yetersizliklerin histopatolojik kesit alınması veya cerrahi teknikile ilgili sorunlar veya skip metastaz varlığı giderilmesive primer tedavide daha agresif yaklaflımların uygulanmasıyla daha iyi sağkalım sonuçları sağlanabilir

Anahtar Kelimeler:

Karsinom, skuamöz hücreli/cerrahi, bafl-boyun neoplazmları/cerrahi, hyoid kemiği, dudak neoplazmları/patoloji/cerrahi, lenf nodu eksizyonu/yöntem, lenfatik metastaz, neoplazm rekürensi, lokal, radikalboyun diseksiyonu, risk faktörleri

Occult lymph node metastasis in lower lip cancers and approach to N0neck

Objectives: İn this study, we evaluated the inci- dence of occult lymph node metastasis and the approach to No necks in carcinoma of the lower lip.Patients and Methods: Sixty-eight patients who undervvent surgery for squamous celi carcinoma of the lower lip were monitored for a minimum period of three years. AH the patients were males mean age 54 years; range 36 to 69 years . Preoperatively, 15 and 53 patients had N+ and No necks, respectively. Depending on the tumor localization, unilateral or bilateral suprahy oid neck dissections were performed. Nine patients undervvent radical neck dissection follovving detection of metastasis on histopathologic examination.Results: Histopathologic examination revealed metastasis in four patients 4/15; 26% with N+ necks and in five patients 5/53; 9.4% with No necks. Four patients 6.7% developed late cervical lymph node metastasis at level 3. No evidence of neck disease was encountered in 93% of patients.Conclusion: Suprahyoid neck dissection appears to be effective in detecting occult lymph node metasta sis. With improved surgical and histopathologic techniques and consideration of skip metastasis, more aggressive treatment approaches may be employed and better survival rates maybe obtained.

Keywords:

Carcinoma, squamous cell/surgery, head and neck neoplasms/surgery, hyoid bone, lip neoplasms/ pathology/surgery, lymph node excision/methods, lymphatic metastasis, neoplasm recurrence, local, radical neck dissection, risk factors,

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Wurman LH, Adams GL, Meyerhoff WL. Carcinoma of the lip. Am J Surg 1975;130:470-4.
Kowalski LP, Magrin J, Waksman G, Santo GF, Lopes ME, de Paula RP, et al. Supraomohyoid neck dissection in the treatment of head and neck tumors. Survival results in 212 cases. Arch Otolaryngol Head Neck Surg 1993;119:958-63.
Cruse CW, Radocha RF. Squamous cell carcinoma of the lip. Plast Reconstr Surg 1987;80:787-91.
Baker SR, Krause CJ. Carcinoma of the lip. Laryngoscope 1 9 8 0 ; 9 0 : 1 9 - 2 7 .
Strasnick B, Moore DM, Abemayor E, Juillard G, Fu YS. Occult primary tumors. The management of isolat- ed submandibular lymph node metastases. Arc h Otolaryngol Head Neck Surg 1990;116:173-6.
Jorgensen K, Elbrond O, Andersen AP. Carcinoma of the lip. A series of 869 cases. Acta Radiol Ther Phys Biol 1973;12:177-90.
Koç C, Akyol MU, Çelikkanat S, Çekiç A, Özdem C. Role of suprahyoid neck dissection in the treatment of squamous cell carcinoma of the lower lip. Ann Otol Rhinol Laryngol 1997;106:787-9.
Enepekides DJ, Sultanem K, Nguyen C, Shenouda G, Black MJ, Rochon L. Occult cervical metastases: i m m u n o p e roxidase analysis of the pathologically nega- tive neck. Otolaryngol Head Neck Surg 1999;120:713-7.
Cowen D, Essomba M, Richaud P, Renaud-Salis JL, Pigneux J. Treatment of cervical lymph nodes in lip can- cers. Bull Cancer Radiother 1990;77:111-7. [Abstract]
de Visscher JG, van den Elsaker K, Grond AJ, van der Wal JE, van der Waal I. Surgical treatment of squamous cell carcinoma of the lower lip: evaluation of long-term results and prognostic factors-a retrospective analysis of 184 patients. J Oral Maxillofac Surg 1998;56:814-20.
Stein AL, Tahan SR. Histologic correlates of metastasis in primary invasive squamous cell carcinoma of the lip. J Cutan Pathol 1994;21:16-21.
Frierson HF Jr, Cooper PH. Prognostic factors in squa- mous cell carcinoma of the lower lip. Hum Pathol 1986;17:346-54.
Wurman LH, Adams GL, Meyerhoff WL. Carcinoma of the lip. Am J Surg 1975;130:470-4.
Hoflal IN, Önerci M, Kaya S, Turan E. Squamous cell carcinoma of the lower lip. Am J Otolaryngol 1992; 13:363-5.
Zitsch RP 3rd. Carcinoma of the lip. Otolaryngol Clin North Am 1993;26:265-77.
Zitsch RP 3rd, Lee BW, Smith RB. Cervical lymph node metastases and squamous cell carcinoma of the lip. Head Neck 1999;21:447-53.
Marshall KA, Edgerton MT. Indications for neck dissec- tion in carcinoma of the lip. Am J Surg 1977;133:216-7.
Eggert JH, Dumbach J, Steinhauser EW. Surgical ther- apy of regional lymph nodes in cancers of the lower lip. Hautarzt 1986;37:444-9. [Abstract]