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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 -
International Journal of Surgery... Jan 2016Recently, several authors introduced various methods and published feasibility studies on novel robotic-assisted neck dissection techniques for head and neck cancer... (Review)
Review
INTRODUCTION
Recently, several authors introduced various methods and published feasibility studies on novel robotic-assisted neck dissection techniques for head and neck cancer patients. Cosmesis and general appearance have become important concerns of cancer patients today. Especially in the head and neck area, a conspicuous scar can reduce patient satisfaction after surgery. With conventional neck dissection techniques, a long scar in the neck is unavoidable. Therefore, the development of robotic assisted neck dissection provides the patients with a scarless neck in these situations. However, there are some limitations of the application of these techniques in their current stage of development.
METHODS
This study was performed using a systematic literature review.
RESULTS
The reviewed clinical studies show that robotic-assisted neck dissection yields similar functional and early oncologic outcomes to that of conventional neck dissection, as well as excellent cosmetic satisfaction of patients. Despite these benefits, some disadvantages can be observed, in terms of longer operation times as well as higher procedure costs.
CONCLUSION
Besides the similar oncologic and functional outcomes compared with the open procedure so far, more prospective, controlled, multicenter studies are required to establish robotic-assisted neck dissection as an alternative standard and to justify its added costs beyond the cosmetic advantages.
Topics: Esthetics; Head and Neck Neoplasms; Humans; Neck Dissection; Operative Time; Patient Satisfaction; Prospective Studies; Robotic Surgical Procedures; Thyroid Neoplasms; Thyroidectomy
PubMed: 26602968
DOI: 10.1016/j.ijsu.2015.11.022 -
Asian Journal of Surgery Oct 2022The objective of this study was to systematically evaluate the effectiveness and safety of endoscopic-assisted lateral neck dissection (EALND) compared with conventional... (Meta-Analysis)
Meta-Analysis Review
The objective of this study was to systematically evaluate the effectiveness and safety of endoscopic-assisted lateral neck dissection (EALND) compared with conventional open lateral neck dissection (COLND) for the treatment of thyroid cancer with positive lymph node metastases. Medical literature databases including PubMed, Embase, the Cochrane Library, CNKI, Wan Fang and VIP were systematically searched for articles that compared EALND and COLND for the treatment of thyroid carcinoma with lymph node metastasis, up to June 2019. The quality of included studies was evaluated using the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using RevMan 5.3 software after two evaluators independently screened the literature, extracted information and evaluated the methodological quality of included studies according to inclusion and exclusion criteria, resulting in the selection of seven studies with a total of 372 patients from six non-RCTs and an RCT. The results of meta-analysis showed that EALND was associated with a longer operative time (MD = 24.86, 95∗CI:21.76 to 27.96, P<0.05), with a shorter postoperative stay (MD = -1.45, 95%CI:-2.70 to -0.21,P = 0.02), reduced length of scar (MD = -8.14,95%CI:-8.41 to -7.88, P<0.00001) and a lower incidence of neck discomfort (OR = 0.19, 95%CI:0.07 to 0.58, P = 0.003) compared with COLND. The incidences in both groups of transient hypocalcemia (OR = 0.66,95%CI:0.28 to 1.55,P = 0.343), transient hoarseness (OR = 0.58,95%CI:0.17 to 1.93,P = 0.38),chylous fistula (OR = 0.69,95%CI:0.26 to 1.83,P = 0.45), choking on water (OR = 0.24,95%CI:0.04 to 1.31,P = 0.10) and the number of lymph nodes retrieved from the lateral cervical region (MD = 0.14,95%CI:-0.36 to 0.65,P = 0.59) were not statistically significant. It was concluded that EALND was safe and feasible compared with COLND, despite the longer operation time. The incision was more aesthetically pleasing and the postoperative recovery was quicker, which makes EALND a clinical procedure worthy of use in such cases.
Topics: Carcinoma, Papillary; Endoscopy, Gastrointestinal; Humans; Lymph Nodes; Lymphatic Metastasis; Neck Dissection; Thyroid Neoplasms; Thyroidectomy
PubMed: 34649793
DOI: 10.1016/j.asjsur.2021.09.030 -
Annals of the Royal College of Surgeons... Nov 1980Animal and clinical studies of a new approach in general surgery using an ultrasonic aspiration device have been encouraging. On 31 patients 11 liver procedures, 12...
Animal and clinical studies of a new approach in general surgery using an ultrasonic aspiration device have been encouraging. On 31 patients 11 liver procedures, 12 extensive head and neck dissections, 5 ultrasonic fulgurations for rectal cancer, and excision of 2 local oral lesions, 1 para-aortic mass, 1 pancreatic cancer, 1 giant subfascial lipoma, and 1 rectal villous adenoma have been carried out.
Topics: Humans; Liver Diseases; Neck Dissection; Rectal Neoplasms; Suction; Surgical Instruments; Ultrasonics
PubMed: 7436305
DOI: No ID Found -
Ear, Nose, & Throat Journal Jun 2021Cutaneous head and neck melanoma is a separate subgroup of cutaneous melanoma that has a worse prognosis than other primary sites. The aim of this article is to examine...
Cutaneous head and neck melanoma is a separate subgroup of cutaneous melanoma that has a worse prognosis than other primary sites. The aim of this article is to examine the significance of sex and site of primary lesion as additional risk factors. Primary localization distribution and metastatic disease in the neck in a retrospective cohort of 159 patients with cutaneous head and neck malignant melanoma were analyzed. Men develop primary melanoma more frequently than women in the left peripheral head and neck regions ( = .0364), as well as clinically visible and occult metastatic disease in the left side of the neck ( = .0138). Patients with clinically occult regional metastatic disease showed a significantly poorer survival rate than the rest of the group that underwent elective neck dissections ( = .0270). Left-sided disease in male patients may be an additional risk factor in cutaneous head and neck melanoma. Performing elective neck dissections in high-risk patients might identify patients with occult metastatic disease and worse prognosis but does not offer any significant therapeutic benefit.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Head; Head and Neck Neoplasms; Humans; Male; Melanoma; Middle Aged; Neck; Neck Dissection; Prognosis; Retrospective Studies; Sex Factors; Skin Neoplasms; Survival Rate; Young Adult; Melanoma, Cutaneous Malignant
PubMed: 31547714
DOI: 10.1177/0145561319875949 -
Annals of the Royal College of Surgeons... Nov 2022Cadaveric dissection courses have come to a standstill since the onset of the COVID-19 pandemic. In addition to limited operative opportunities, cancellation of such...
INTRODUCTION
Cadaveric dissection courses have come to a standstill since the onset of the COVID-19 pandemic. In addition to limited operative opportunities, cancellation of such courses has severely impacted surgical training, especially in a craft-based specialty such as head-neck surgery. The aim of this educational project was to: (1) study the feasibility of an in-person head-neck cadaveric dissection course during COVID-19 pandemic; and (2) validate the educational benefit of this teaching method to ear, nose and throat (ENT) trainees.
METHODS
We developed a 2-day head-neck cadaveric dissection course for ENT trainees. The course programme covered essential head-neck open surgical procedures. Content validity (subjective feedback) was assessed using a 5-point Likert scale. Construct validity (objective usefulness) was evaluated via two pre- and post-course questionnaires, estimating knowledge of head-neck surgical anatomy and self-assessment of levels of confidence with head-neck procedures, respectively.
RESULTS
A risk assessment was conducted and a protocol developed (risk was deemed to be low/tolerable). Content validity showed high satisfaction compared with a median Likert score of 3, 'average' (=0.000002). For construct validity, the mean score per question improved significantly (=0.001). Overall levels of confidence showed a trend towards improvement (=0.08). There was significant improvement in laryngectomy (=0.01) and level I dissection (=0.01), with an indication of improvement in level II-V dissection (=0.07).
CONCLUSIONS
We demonstrated that a cadaveric dissection course, using thorough risk assessment and protocol, could be safely conducted with high content and construct validation during these unprecedented times. This is an invaluable learning environment that needs to be encouraged despite infection control restrictions.
Topics: Humans; Neck Dissection; COVID-19; Pandemics; Dissection; Cadaver; Clinical Competence
PubMed: 35175784
DOI: 10.1308/rcsann.2021.0316 -
Acta Clinica Croatica Jun 2020Well-differentiated cancers, both papillary and follicular, account for 90% of all diagnosed thyroid cancers. They have an indolent disease course with a 20-year... (Review)
Review
Well-differentiated cancers, both papillary and follicular, account for 90% of all diagnosed thyroid cancers. They have an indolent disease course with a 20-year disease-specific survival over 90%. According to current guidelines, the therapy of choice for well-differentiated thyroid carcinoma is total thyroidectomy or lobectomy. The indication for prophylactic central neck dissection is still a controversial issue and the subject of unfinished and ongoing debate. There is no indication for prophylactic central neck dissection in follicular thyroid carcinomas, which primarily metastasize hematogenously. In small solitary papillary thyroid carcinomas (T1 and T2), prophylactic central neck dissection is not indicated as it does not bring benefits in terms of improved patient survival and at the same time significantly increases the risk of temporary and permanent postoperative complications. Prophylactic central neck dissection is indicated in advanced papillary thyroid cancers (T3 and T4) and all other high-risk well-differentiated thyroid cancer, as well as in the presence of metastatic lymph nodes in the lateral neck.
Topics: Humans; Neck Dissection; Neoplasm Recurrence, Local; Thyroid Cancer, Papillary; Thyroid Neoplasms; Thyroidectomy
PubMed: 34219889
DOI: 10.20471/acc.2020.59.s1.11 -
Cancer Dec 2021The survival benefit of elective neck dissection (END) for patients with cutaneous squamous cell carcinoma (cSCC) of the head and neck and no evidence of regional...
BACKGROUND
The survival benefit of elective neck dissection (END) for patients with cutaneous squamous cell carcinoma (cSCC) of the head and neck and no evidence of regional metastasis (cN0) has never been reported. The aim of this study was to determine the effect of END on patient survival.
METHODS
The authors included patients with head and neck cSCC who had undergone primary surgery from 1995 to 2017. The primary end point was survival, and the secondary end points were the incidence of occult regional disease and regional disease control. To assess the impact of END on survival, the authors used multivariable Cox proportional hazards models with propensity score and matching techniques for internal validation.
RESULTS
A total of 1111 patients presented with no evidence of nodal disease; 173 had END, and 938 were observed. Adjuvant radiotherapy to the neck was administered to 101 patients (9%). END resulted in a 5-year overall survival rate of 52%, whereas the rate was 63% in the observation group (P = .003 [log-rank]). The 5-year disease-free survival rate for patients undergoing END was similar to that for the observation group (73% vs 75%; P = .429). A multivariate regression model showed that the performance of END was not associated with improved rates of overall, disease-specific, or disease-free survival; similarly, among patients with advanced disease (T3-4), those who underwent END did not have improved survival rates.
CONCLUSIONS
Among patients with cSCC of the head and neck, observation of the neck nodes resulted in noninferior survival rates in comparison with END at the time of primary surgery. Further studies are required to elucidate the role of END in patients with advanced disease.
Topics: Carcinoma, Squamous Cell; Head and Neck Neoplasms; Humans; Lymphatic Metastasis; Neck Dissection; Neoplasm Staging; Retrospective Studies; Skin Neoplasms
PubMed: 34358340
DOI: 10.1002/cncr.33773 -
Anatomical Record (Hoboken, N.J. : 2007) Jun 2021In the attempt to improve the cosmetic and functional outcomes in head and neck surgeries, robotic or video-assisted neck dissection using remote access has gained...
In the attempt to improve the cosmetic and functional outcomes in head and neck surgeries, robotic or video-assisted neck dissection using remote access has gained ground in recent years. Retroauricular approach emerged as the most versatile option, allowing proper dissection at all neck levels. In this technique, after retroauricular incision, a skin flap is elevated and a self-retaining retractor is placed, creating working space for the robotic, or endoscopic neck dissection. Numerous published series have shown the safety and favorable outcomes of retroauricular robotic neck dissections, without any major complications or surgery-related deaths. The only consistently reported disadvantage is a longer operative time. Our group has an experience of 190 retroauricular neck dissections performed over the last 5 years, without any major setbacks. The oncologic and safety outcomes have been comparable to the conventional technique, with clearly superior aesthetic results. In the process of expansion of Robotic Surgery in Brazil, our center is currently providing training and proctoring to capacitate other head and neck surgeons, and enable other centers to offer this surgical modality.
Topics: Humans; Neck; Neck Dissection; Robotic Surgical Procedures; Thyroidectomy
PubMed: 33773074
DOI: 10.1002/ar.24621 -
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