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ORIGINAL RESEARCH

Is Prophylactic Neck Dissection a “Must” in Early-stage Lip Cancer?
Erken Evre Dudak Kanserlerinde Profilaktik Boyun Diseksiyonu Şart mıdır?
Received Date : 19 Jun 2023
Accepted Date : 27 Sep 2023
Available Online : 06 Oct 2023
Doi: 10.24179/kbbbbc.2023-98550 - Makale Dili: EN
Journal of Ear Nose Throat and Head Neck Surgery. 2023;31(4):200-5.
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: Standard lip cancer (LC) treatment is surgical excision with therapeutic neck dissection (ND) when there is detectable metastasis to the cervical lymph nodes (LNs). Nevertheless, there is no general agreement over how to approach to N0 neck in LC. The aim of this study is retrospectively review the prognoses of T1/T2 N0 LC-cases who underwent prophylactic ND, for justification of this procedure. Material and Methods: The study included 50 consecutive early-stage LC-patients, who were operated on between 2013 and 2023. A retrospective review was made of the clinical findings including tumor location, T-grade, detectable regional LN involvements, surgical and adjuvant therapies, histopathological results, recurrences, and metastases. Results: The 50 patients comprised of 36 (72%) males and 14 (28%) females with a 70.94 years mean age. Squamous cell carcinoma was the unanimous histologic diagnosis. The tumors were T2 in 12 (24%) and T1 in 38 (76%) patients; well, moderately and poorly differentiated in 22 (44%), 27 (54%), and 1 (2%) cases, respectively. Tumor locations were as follows: 42 (84%) lower lip, 7 (14%) upper lip, 1 (2%) commissure. Resected tumor defects were repaired with primary closure or flap repairs in 38 (76%) patients and in 12 (24%) patients the operations were complemented with unilateral or bilateral (8 and 4 cases, respectively) elective supraomohyoid ND. No LN metastases were found histopathologically in the ND-specimens. Tumor recurrences occurred in 2 (4%) patients. Conclusion: The results of this study suggested that “wait-and-see” and close follow-up at regular intervals is a more rational approach in early-stage N0 LC than prophylactic ND.
ÖZET
Amaç: Standart dudak kanseri tedavisi, servikal lenf nodlarında saptanabilir metastaz olduğunda cerrahi eksizyon ve terapötik boyun diseksiyonu şeklindedir. Erken evre (T1 ve T2) dudak kanserlerinde lenf nodu tutulumu negatif (N0) boyuna yaklaşım tartışmalıdır. Bu çalışmanın amacı, profilaktik boyun diseksiyonu uygulanan T1/T2 N0 dudak kanseri vakalarının prognozlarını retrospektif olarak gözden geçirmektir. Gereç ve Yöntemler: Çalışmaya 2013 ile 2023 yılları arasında erken evre primer dudak karsinomu nedeni ile opere edilen 50 ardışık hasta dâhil edildi. Hastaların klinik özellikleri, bölgesel lenf nodu durumu, tümörün yerleşim yeri, tümör evrelemesi, patoloji sonuçları, takiplerde nüks oranları, boyun lenf nodu metastazı ve uzak metastaz oranları geriye dönük olarak incelendi. Bulgular: Hastaların 14’ü (%28) kadın, 36’sı (%72) erkek idi ve yaş ortalaması 70,94 yıl idi. Olguların tamamında patolojik tanı skuamöz hücreli karsinomdu. On iki (%24) hastada T2, 38 (%76) hastada T1 tümör mevcuttu. Tümörler 22 (%44) hastada iyi, 27 (%54) hastada orta, 1 (%2) hastada az derecede diferansiye idi. Kanserlerin 7’si (%14) üst dudakta, 42’si (%84) alt dudakta, 1’i (%2) ise kommissür bölgesinde izlendi. Hastaların 38’ine kitle eksizyonu ve primer ya da fleb ile onarım yapılırken, 12’sine (6 hasta pT1, 6 hasta pT2) ek olarak profilaktik boyun diseksiyonu yapıldı. Dört hastaya bilateral, 8 hastaya ise tek taraflı supraomohyoid boyun diseksiyonu yapıldı. Hastaların herhangi birinde histopatolojik lenf nodu metastazı izlenmedi. İki hastada lokal nüks izlendi. Sonuç: Erken evre N0 dudak kanserlerinde profilaktik boyun diseksiyonunun gerekli olmayacağı kanaati oluştu ve bu hasta grubu için “bekle ve gör” ve düzenli aralıklarla yakın takip yaklaşımının daha uygun bir seçenek gibi göründüğü sonucuna varıldı.
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