| Autor: |
J. Tulenko, F. S. Hoffmeister, R. L. Priore |
| Rok vydání: |
1966 |
| Předmět: |
|
| Zdroj: |
The American Journal of Surgery. 112:562-568 |
| ISSN: |
0002-9610 |
| DOI: |
10.1016/0002-9610(66)90323-0 |
| Popis: |
In this report ninety-six consecutive en bloc resections (Commando) are analyzed. Comparison is made using thirty consecutive staged excisions of the primary lesion followed by neck dissection when lymphadenopathy developed. 1.1. The nodal palpability is of prognostic significance: the five year cure rate was 50 per cent in the patients with nonpalpable nodes and 27 per cent in those with palpable nodes. (Table II.) The histologic presence of metastasis is more prognostically meaningful than nodal palpability: the five year cure rate was 68 per cent in the group histologically negative for metastasis. (Table III.) Combined palpability and pathologic findings are prognostically most significant: the five year cure rate was 76 per cent in the patients with nonpalpable nodes which were histologically negative and 11 per cent in the patients with palpable nodes which were histologically positive. (Table IV.) Of the characteristics of the primary lesion, only involvement of the floor of the mouth had prognostic significance. (Table VI.) The size and location of the lesion and the histologic differentiation did not affect cure rates. 2.2. Local recurrence of the primary lesion was the most frequent cause of treatment failures. (Table VII.) The high incidence of treatment failures due to local recurrence emphasizes the need for more adequate excision of the primary lesion. 3.3. Palpability of neck nodes is an unreliable index for determining the presence of metastasis. (Table VIII.) When the nodes were not palpable, metastasis was present (false-negative) in 52 per cent of the cases; when the nodes were palpable, it was absent (false-positive) in 33 per cent. It appears that neck dissection was unnecessary in 48 per cent of the patients with nonpalpable nodes and in 33 per cent of those with palpable nodes. 4.4. The high incidence of unnecessary neck dissections suggests the need for reducing their number, if possible. Since neither the nodal palpability nor the characteristics of the primary lesion allows predicting the presence of metastasis with acceptable accuracy, the question arises as to whether stricter criteria and staging the excision of the primary lesion and neck dissection would reduce the number of unnecessary neck dissections without adversely affecting the cure rates. The data (Table X) suggest that staging is an acceptable therapeutic alternative in selected lesions, that is, in those of limited size and easy accessibility and in the absence of palpable nodes. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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