Oncologic safety of preserving cervical nerves in neck dissection

DOI 1 Citations 27 References
  • Honda Keigo
    National Hospital Organization Kyoto Medical Center, Department of Head and Neck surgery
  • Asato Ryo
    National Hospital Organization Kyoto Medical Center, Department of Head and Neck surgery
  • Tsuji Jun
    National Hospital Organization Kyoto Medical Center, Department of Otolaryngology
  • Kanda Tomoko
    National Hospital Organization Kyoto Medical Center, Department of Head and Neck surgery
  • Watanabe Yoshiki
    National Hospital Organization Kyoto Medical Center, Department of Otolaryngology
  • Mori Yusuke
    National Hospital Organization Kyoto Medical Center, Department of Head and Neck surgery
  • Tsujimura Takashi
    National Hospital Organization Kyoto Medical Center, Department of Otolaryngology

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  • 頸部郭清における頸神経温存の腫瘍学的安全性

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Abstract

Preservation of cervical nerves is the latest modification in neck dissection for head and neck cancer. While its functional merit has been reported in a few papers, its oncologic safety has remained unclear. We conducted a retrospective chart review on previously untreated 104 head and neck cancer patients who had undergone neck dissection at Kyoto Medical Center between April 2009 and June 2011. The mean age was 65 years old and the mean observation period was 584 days. Neck dissection was performed on a total of 154 sides of neck, including 66 elective and 90 therapeutic dissections. The cervical nerves were preserved in 90.4% (19/21 sides) of elective neck dissection in patients with clinically early stage diseases and 60.0% (27/45 sides) in patients with clinically advanced stage diseases. In therapeutic dissections, the cervical nerves were preserved in 31.1% (28/90 sides) of dissections. No recurrences in dissected fields were observed. Occult lymph node metastases were found in 23.0% (17/74 sides) after neck dissection preserving cervical nerves, with the mean number of metastatic nodes of 2.1. Extracapsular spread was absent in occult metastatic nodes in this series. <br>The results showed that the preservation of cervical nerves is oncologically safe in selected cases. The scarcity of extracapsular spread by occult lymph node metastases indicates there is little, if any, risk of disseminating cancer cells during the procedure to preserve cervical nerves in elective neck dissections. Therefore, the good indications of preservation of cervical nerves should include elective neck dissection, regardless of clinical stage.

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