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Current Opinion in Otolaryngology &... Apr 2020The progressive growth of endoscopic and robotic-assisted procedures provided the tools for development of remote approaches to the neck, which could avoid a visible... (Review)
Review
PURPOSE OF REVIEW
The progressive growth of endoscopic and robotic-assisted procedures provided the tools for development of remote approaches to the neck, which could avoid a visible large neck scar usually necessary for neck dissections. This review explores the current experience with robotic neck dissection, looking for pros and cons in surgical, oncologic and aesthetic outcomes.
RECENT FINDINGS
Robotic neck dissection was shown to be feasible and well tolerated, with adequate oncological outcomes in different tumours. Although difficult to objectively analyse, cosmetic satisfaction seems to be significatively higher in patients submitted to this procedure when compared with those submitted to conventional neck dissection. The only consistently reported disadvantage was longer operative time. Other potential advantages beyond cosmesis such as improvements on oedema, fibrosis, neck movement, sensory loss and social interactions were not well explored so far.
SUMMARY
Surgical treatment of neck metastasis had several evolutions in the last decades. Robotic neck dissection emerged as an option to avoid extensive visible neck scars, improving cosmesis and probably other functional outcomes, although securing oncologic effectiveness. Technological innovation is increasingly dynamic, promising progressive evolution in robotic surgery. Together, the lack of objective data on functional outcomes warrants the need for further investigation on robotic neck dissection.
Topics: Cicatrix; Esthetics; Head and Neck Neoplasms; Humans; Neck Dissection; Robotic Surgical Procedures
PubMed: 32102004
DOI: 10.1097/MOO.0000000000000617 -
Endocrinology and Metabolism Clinics of... Mar 2019The incidence of thyroid cancer is increasing, largely attributable to overdetection related to prevalent diagnostic and radiologic imaging modalities. Papillary thyroid... (Review)
Review
The incidence of thyroid cancer is increasing, largely attributable to overdetection related to prevalent diagnostic and radiologic imaging modalities. Papillary thyroid cancer remains the most common thyroid malignancy. It has a high tendency for regional metastasis to the cervical lymph nodes. The optimal management of the neck in patients with thyroid carcinoma has long been an important topic of debate. This article addresses central and lateral neck dissection, providing a simplified guide to the most up-to-date and evidence-based practices.
Topics: Humans; Neck Dissection; Thyroid Neoplasms; Thyroidectomy
PubMed: 30717898
DOI: 10.1016/j.ecl.2018.11.004 -
Oral Oncology Mar 2019In 1994 a decision analysis, based on the literature and utility ratings for outcome by a panel of experienced head and neck physicians, was presented which showed a... (Review)
Review
In 1994 a decision analysis, based on the literature and utility ratings for outcome by a panel of experienced head and neck physicians, was presented which showed a threshold probability of occult metastases of 20% to recommend elective treatment of the neck. It was stated that recommendations for the management of the cN0 neck are not immutable and should be reconfigured to determine the optimal management based on different sets of underlying assumptions. Although much has changed and is published in the almost 25 years after its publication, up to date this figure is still mentioned in the context of decisions on treatment of the clinically negative (cN0) neck. Therefore, we critically reviewed the developments in diagnostics and therapy and modeling approaches in the context of decisions on treatment of the cN0 neck. However, the results of studies on treatment of the cN0 neck cannot be translated to other settings due to significant differences in relevant variables such as population, culture, diagnostic work-up, follow-up, costs, institutional preferences and other factors. Moreover, patients may have personal preferences and may weigh oncologic outcomes versus morbidity and quality of life differently. Therefore, instead of trying to establish "the" best strategy for the cN0 neck or "the" optimal cut-off point for elective neck treatment, the approach to optimize the management of the cN0 neck would be to develop and implement models and decision support systems that can serve to optimize choices depending on individual, institutional, population and other relevant variables.
Topics: Carcinoma, Squamous Cell; Decision Support Techniques; Elective Surgical Procedures; Humans; Lymphatic Metastasis; Mouth Neoplasms; Neck Dissection; Patient Preference; Prognosis; Quality of Life; Shoulder Pain
PubMed: 30846183
DOI: 10.1016/j.oraloncology.2019.01.016 -
Frontiers in Endocrinology 2021Endoscopic thyroidectomy and robotic thyroidectomy are effective and safe surgical options for thyroid surgery, with excellent cosmetic outcomes. However, in regard to... (Review)
Review
BACKGROUND
Endoscopic thyroidectomy and robotic thyroidectomy are effective and safe surgical options for thyroid surgery, with excellent cosmetic outcomes. However, in regard to lateral neck dissection (LND), much effort is required to alleviate cervical disfigurement derived from a long incision. Technologic innovations have allowed for endoscopic LND, without the need for extended cervical incisions and providing access to remote sites, including axillary, chest-breast, face-lift, transoral, and hybrid approaches.
METHODS
A comprehensive review of published literature was performed using the search terms "lateral neck dissection", "thyroid", and "endoscopy OR endoscopic OR endoscope OR robotic" in PubMed.
RESULTS
This review provides an overview of the current knowledge regarding endoscopic LND, and it specifically addresses the following points: 1) the surgical procedure, 2) the indications and contraindications, 3) the complications and surgical outcomes, and 4) the technical advantages and limitations. Robotic LND, totally endoscopic LND, and endoscope-assisted LND are separately discussed.
CONCLUSIONS
Endoscopic LND is a feasible and safe technique in terms of complete resection of the selected neck levels, complications, and cosmetic outcomes. However, it is recommended to strictly select criteria when expanding the population of eligible patients. A formal indication for endoscopic LND has not yet been established. Thus, a well-designed, multicenter study with a large cohort is necessary to confirm the feasibility, long-term outcomes, oncological safety, and influence of endoscopic LND on patient quality of life (QoL).
Topics: Endoscopy; Humans; Neck Dissection; Robotic Surgical Procedures; Thyroid Gland; Thyroid Neoplasms; Thyroidectomy
PubMed: 35002974
DOI: 10.3389/fendo.2021.796984 -
Minerva Chirurgica Feb 2010The presence of lymph node metastasis to the neck is accepted as one of the single most important adverse prognostic indicators of survival in squamous cell carcinoma of... (Review)
Review
The presence of lymph node metastasis to the neck is accepted as one of the single most important adverse prognostic indicators of survival in squamous cell carcinoma of the head and neck. Neck dissection in its various forms is the standard surgical treatment for clinical and subclinical metastatic cancer to the neck. This paper is a review of the anatomy of the neck, history and specific types of neck dissection, indications, therapeutic options, and current challenges in the treatment of metastatic neck disease.
Topics: Forecasting; Head and Neck Neoplasms; Humans; Lymphatic Metastasis; Neck; Neck Dissection
PubMed: 20212417
DOI: No ID Found -
European Archives of... Nov 2013It has been established that an appropriately indicated selective neck dissection can achieve the same oncologic results as more extensive dissections. An even more... (Review)
Review
It has been established that an appropriately indicated selective neck dissection can achieve the same oncologic results as more extensive dissections. An even more modified selective neck dissection, termed superselective neck dissection, involves the compartmental removal of the fibrofatty tissue contents within the defined boundaries of two or fewer contiguous neck levels. Evidence from retrospective studies suggests that superselective neck dissection (SSND) is oncologically sound for two indications: elective treatment of the clinically N0 neck and salvage treatment of persistent lymph node disease after chemoradiotherapy. While there is broader support for the former scenario, evidence that SSND may constitute optimal treatment in the latter is in conformity with the trend toward developing surgical techniques that provide better functional outcomes without compromising efficacy.
Topics: Carcinoma, Squamous Cell; Head and Neck Neoplasms; Humans; Lymph Nodes; Lymphatic Metastasis; Neck Dissection; Squamous Cell Carcinoma of Head and Neck; Treatment Outcome
PubMed: 23321797
DOI: 10.1007/s00405-012-2344-5 -
Auris, Nasus, Larynx Dec 2006The significance of metastatic disease in the lymph nodes of the neck as a critical independent prognostic factor in head and neck cancer has long been appreciated.... (Review)
Review
The significance of metastatic disease in the lymph nodes of the neck as a critical independent prognostic factor in head and neck cancer has long been appreciated. Although 19th century surgeons attempted to remove involved cervical lymph nodes at the time of resection of the primary cancer, a systematic approach to en bloc removal of cervical lymph node disease, described in detail by Jawdyński in 1888 and popularized and illustrated by Crile in the early 20th century, provided consistent and more effective treatment, and forms the basis of our current techniques. During the first half of the 20th century, developments included preservation of the accessory nerve in selected cases, elective neck dissection performed in association with resection of various primary tumors, bilateral neck dissection and limited neck dissection. The greatest impetus to the status of radical neck dissection came from Martin, whose technique consisted of resection of all lymph nodes from level I-V together with the accessory nerve, internal jugular vein, sternocleidomastoid muscle and various other structures in a single block of resected tissue. Martin's technical precepts were followed until the latter part of the 20th century when modifications in technique began to find general acceptance. The first description of an effective technique of modified radical neck dissection was published in Spanish by Suárez, in 1963. This technique, which preserves important structures, such as the internal jugular vein, sternocleidomastoid muscle and accessory nerve, was refined and popularized by various authors who published their results in the English language literature during the period from 1964 through 1990 and beyond. Modified or "functional" neck dissection avoids much of the morbidity of radical neck dissection while achieving equivalent degrees of control of regional disease in properly selected cases. By the late 20th century, the concept of selective neck dissection, consisting of resection of only the nodal groups at greatest risk for metastasis from a given primary site, was studied and developed. These limited dissections are now widely employed for elective, and in properly selected cases, therapeutic treatment and staging of the neck, and have been proposed for limited cervical recurrences after various chemoradiation protocols. Prospective studies have demonstrated similar rates of neck recurrence and survival after elective selective neck dissection compared to elective modified radical neck dissection. Other modifications and factors applied to treatment of cervical lymph node disease include the use of adjuvant and neo-adjuvant radiation and chemotherapy, a revised system for classification of neck dissections, the identification of various adverse prognostic factors such as extracapsular spread and extranodal soft tissue deposits, application of sentinel lymph node biopsy to staging of the neck, the use of immunohistochemical and molecular techniques for identification of lymph node metastases not detectable by light microscopy, and the possibility of endoscopic neck dissection. The authors conclude that neck dissection, as evolved over the past century, is a fundamental tool in management of patients with head and neck cancer, but is still a work in progress.
Topics: Head and Neck Neoplasms; Humans; Immunohistochemistry; Lymphatic Metastasis; Neck Dissection; Neoadjuvant Therapy; Radiotherapy, Adjuvant; Sentinel Lymph Node Biopsy
PubMed: 16889923
DOI: 10.1016/j.anl.2006.06.001 -
Oral and Maxillofacial Surgery Clinics... Aug 2008Lymph node status is the single most important prognostic factor in head and neck cancer because lymph node involvement decreases overall survival by 50%. Appropriate... (Review)
Review
Lymph node status is the single most important prognostic factor in head and neck cancer because lymph node involvement decreases overall survival by 50%. Appropriate management of the regional lymphatics, therefore, plays a central role in the treatment of the head and neck cancer patients. Performing an appropriate neck dissection results in minimal morbidity to the patient, provides invaluable data to accurately stage the patient, and guides the need for further therapy. The purposes of this article are to present the history and evolution of neck dissections, including an update on the current state of nomenclature and current neck dissection classification, describe the technique of the most common neck dissection applicable to oral cavity cancers, and discuss some of the complications associated with neck dissection. Finally, a brief review of sentinel lymph node biopsy will be presented.
Topics: Hemorrhage; History, 19th Century; History, 20th Century; History, 21st Century; Humans; Lymph Nodes; Lymphatic Metastasis; Mouth Neoplasms; Neck; Neck Dissection; Peripheral Nerve Injuries; Sentinel Lymph Node Biopsy; Terminology as Topic
PubMed: 18603203
DOI: 10.1016/j.coms.2008.02.005 -
British Journal of Plastic Surgery Oct 2004Neck dissection is a valuable procedure for treating metastatic cancers of the head and neck. Radical neck dissection remains the standard for cervical metastasis.... (Review)
Review
Neck dissection is a valuable procedure for treating metastatic cancers of the head and neck. Radical neck dissection remains the standard for cervical metastasis. Because of the morbidity associated with such a treatment, more conservative approaches are being adopted. The authors describe how they do a neck dissection and review the issues that currently surround the choice of treatment.
Topics: Head and Neck Neoplasms; Humans; Lymphatic Metastasis; Neck Dissection; Risk Factors; Sentinel Lymph Node Biopsy
PubMed: 15380694
DOI: 10.1016/j.bjps.2004.05.011 -
Surgical Oncology Clinics of North... Jul 2005
Review
Topics: Head and Neck Neoplasms; History, 19th Century; History, 20th Century; Humans; Lymphatic Metastasis; Mouth Neoplasms; Neck Dissection; Neoplasm Staging; Prognosis
PubMed: 15978424
DOI: 10.1016/j.soc.2005.04.003