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ORIGINAL RESEARCH

Is Bilateral Neck Dissection Necessary in N0 Necks in Laryngeal Cancer? In the Same Session, or Staged Surgery?
Larenks Kanserinde N0 Boyunda Bilateral Boyun Diseksiyonu Gerekli midir? Aynı Seans mı, Farklı Seans mı?
Received Date : 11 Dec 2019
Accepted Date : 12 Feb 2020
Available Online : 17 Feb 2020
Doi: 10.24179/kbbbbc.2019-72864 - Makale Dili: EN
KBB ve BBC Dergisi. 2020;28(1):36-43
Copyright © 2020 by Turkey Association of Society of Ear Nose Throat and Head Neck Surgery. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
ABSTRACT
Objective: In this study, we aimed to determine ipsilateral and contralateral occult neck metastasis rate in patients who underwent bilateral neck dissection due to T1-T4 N0 laryngeal carcinoma, and put forward the need for bilateral neck dissection. Material and Methods: This study included 60 patients who underwent bilateral neck dissections due to T1-T4 N0 laryngeal carcinoma between 1998 and 2015. The patients were divided into three groups according to the localization of the tumor (supraglottic, glottic, and transglottic). Each group was divided into 3 subgroups as unilateral lesion, midline lesion, and unilateral lesion passing across the midline. The neck metastases were classified as ipsilateral, contralateral, or bilateral. Results: The tumor was supraglottic in 14, glottic in 13, and transglottic in 33 patients. There was neck metastasis in 9 of 60 patients (3 patients had N1, 3 patients had N2b, and 3 patients had N2c necks). Contralateral neck metastasis was not seen in any of the patients with unilateral tumors. Contralateral neck metastasis was not evident when there was not an ipsilateral neck metastasis. The rate of contralateral neck metastasis in presence of ipsilateral neck metastasis was 33% in supraglottic, 50% in glottic T4a, and 25% in transglottic tumors. Conclusion: The results of this study indicated that unilateral neck dissection was sufficient in all groups in case of unilateral tumors, and unilateral tumors passing across the midline when there is no ipsilateral neck metastasis, but bilateral neck dissection is needed in midline tumors.
ÖZET
Amaç: Bu çalısmada amacımız, T1-T4 N0 larinks kanseri nedeniyle bilateral boyun diseksiyonu yapılan hastalarda, lezyon tarafı ve kontralateral occult metastaz oranlarını saptayarak, bilateral boyun diseksiyonu gerekliligini belirlemektir. Gereç ve Yöntemler: Bu çalışmada 1998-2015 yılları arasında, T1-T4 N0 larinks kanseri nedeniyle bilateral boyun diseksiyonu uygulanan 60 hasta değerlendirilmiştir. Hastalar tümör lokalizasyonuna göre 3 grupta incelenmiştir (supraglottik, glottik, transglottik). Her grup kendi içinde tek taraflı lezyon, orta hat ve orta hattı geçmiş tek taraflı lezyon seklinde 3 gruba ayrıldı. Tüm grupların metastaz oranları unilateral, kontralateral ve bilateral olarak sınıflandırıldı. Bulgular: Tümör, 14 hastada supraglottik, 13 hastada glottik, 33 hastada transglottik idi. Altmış hastanın 9’unda boyun metastazı saptandı (3 N1, 3 N2b,3 N2c). Tek taraflı lezyonların hiçbirinde karşı tarafta metastaz tespit edilmedi. Lezyon tarafında metastaz saptanmayan olguların hepsinde karsı tarafta da metastaz saptanmadı. Lezyon tarafında metastaz saptanan olgularda karsı tarafta metastaz saptanma oranı supraglottik lezyonlarda %33, glottik T4a lezyonlarda %50, transglottik lezyonlarda %25 olarak saptandı. Sonuç: Bu bulgular tum lezyon gruplarında tek taraflı ve orta hattı geçen tek taraflı tümörlerde lezyon tarafında metastaz saptanmaması durumunda unilateral boyun diseksiyonunun yeterli olduğu, orta hat lezyonlarında ise bilateral boyun diseksiyonu yapılmasının uygun olacağı sonucunu ortaya koymaktadır.
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