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01-01-2008 | Head and Neck Oncology

Preservation of the Internal Jugular Vein in the Radical Treatment of Node-Positive Neck—Is It Safe?

Authors: Everton Pontes Martins, MD, João Gonçalves Filho, MD, PhD, Ivan Marcelo Gonçalves Agra, MD, André Lopes Carvalho, MD, PhD, José Magrin, MD, PhD, Luiz Paulo Kowalski, MD, PhD

Published in: Annals of Surgical Oncology | Issue 1/2008

Abstract

Background

The aim of this study was to evaluate risk factors of neck recurrence in patients with pN+ necks submitted to a modified or a classic radical neck dissection and the safety of preserving the internal jugular vein in the treatment of a subgroup of these patients.

Methods

The medical records of 311 untreated patients with squamous cell carcinoma of the oral cavity (106 cases), oropharynx (95 cases), larynx (49 cases), and hypopharynx (61 cases) were reviewed. Their clinical stages (CS) were CS II in 1%, CS III in 19.9%, CS IVA in 76.2%, and CS IVB in 19.6% of the cases. All patients were pN+.

Results

Ipsilateral neck recurrence occurred in 18 cases (5.8%), 14 cases (4.5%) where the internal jugular vein was resected, and 4 cases (1.3%) where the internal jugular vein was preserved. Neck recurrence did not have significant correlation with tumor site (P = .852), T stage (P = .369), N stage (P = .963), adjuvant radiotherapy (P = .701), number of positive lymph nodes (P = .886), jugular vein preservation (P = .240), and extracapsular spread (P = .670). There was significant correlation between neck recurrence and the lymph node size (.040).

Conclusions

Modified radical neck dissection with internal jugular vein preservation can be performed in selected patients with lymph node metastases, with no significant increase in the risk of neck recurrence.

Crile GW. On the surgical treatment of cancer of the head and neck. With a summary of one hundred and twenty-one operations performed upon one hundred and five patients. Trans South Surg Gynecol Assoc 1905; 18:108–27

Crile GW. Excision of cancer of the head and neck. With special reference to the plan of dissection based on one hundred and thirty-two operations. JAMA 1906; 47:1780–8

Martin H, Del Valle B, Ehrlich H, Cahan WG. Neck dissection. Cancer 1951; 4:441–99PubMedCrossRef

Nahum AM, Mullaly W, Marmor L. A syndrome resulting from radical neck dissection. Arch Otolaryngol 1961; 74:424–8PubMed

Gius JA, Grier DH. Venous adaptation following bilateral radical neck dissection with excision of the jugular veins. Surgery 1950; 28:305–21PubMed

Sugarbaker ED, Wiley HM. Intracranial-pressure studies incident to resection of the internal jugular veins. Cancer 1951; 4:242–50PubMedCrossRef

Suarez O. El problema de las metastasis linfaticas y alejadas del cancer de laringe e hipofaringe. Rev Otorrinolaring 1963; 23:83–99

Skolnik EM, Tenta LT, Wineinger DM, Tardy ME. Preservation of XI cranial nerve in neck dissections. Laryngoscope 1967; 77:1304–4PubMedCrossRef

Bocca E, Pignataro O. A conservation technique in radical neck dissection. Ann Otolaryngol 1967; 76:975–87

10.

Djalilian M, Weiland LH, Devine KD, Beahrs OH. Significance of jugular vein invasion by metastatic carcinoma in radical neck dissection. Am J Surg 1973; 126:566–69PubMedCrossRef

11.

DeSanto LW, Beahrs OH. Modified and complete neck dissection in the treatment of squamous cell carcinoma of the head and neck. Surg Gynecol Obstet 1988; 167:259–69PubMed

12.

Harish K. Neck dissections: radical to conservative. World J Surg Oncol 2005; 18:3–21

13.

Bland KI, Karakousis CP, Copeland EM. Atlas of Surgical Oncology. Philadelphia: WB Saunders Company, 1995

14.

Barbosa JF. Radical laryngectomy with bilateral neck dissection in continuity. Arch Otolaryngol 1956; 63:372–83

15.

Magrin J, Kowalski LP. Bilateral radical neck dissection: results in 193 cases. J Surg Oncol 2000; 75:232–40PubMedCrossRef

16.

TNM 6th edition UICC (União Internacional Contra o Câncer—2002)

17.

Ferlito A, Robbins KT, Shaha AR, et al. Current considerations in neck dissection. Acta Otolaryngol 2002; 122:323–29PubMedCrossRef

18.

Ferlito A, Rinaldo A, Robbins KT, et al. Changing concepts in the surgical management of the cervical node metastasis. Oral Oncol 2003; 39:429–35PubMedCrossRef

19.

Weingarten CZ. Simultaneous bilateral radical neck dissection. Arch Otolaryngol 1973; 97:309–11PubMed

20.

Dulguerov P, Soulier C, Maurice J, et al. Bilateral radical neck dissection with unilateral internal jugular vein reconstruction. Laryngoscope 1998; 108:1692–6PubMedCrossRef

21.

Katsuno S, Ishiyama T, Nezu K, Usami S. Three types of internal jugular vein reconstruction in bilateral radical neck dissection. Laryngoscope 2000; 110:1578–80PubMedCrossRef

22.

Ferlito A, Kowalski LP, Byers RM, et al. Is the standard radical neck dissection no longer standard? Acta Otolaryngol 2002; 122:792–95PubMedCrossRef

23.

Kowaslki LP, Carvalho AL. Feasibility of supraomohyoid neck dissection in N1 and N2a oral cancer patients. Head Neck 2002; 24:921–4CrossRef

24.

Kolli VR, Datta RV, Orner JB, Hicks JR WL, Loree TR. The role of supraomohyoid neck dissection in patients with positive nodes. Arch Otolaryngol 2000; 126:413–6

25.

Buckley JG, Feber T. Surgical treatment of cervical node metastases from squamous carcinoma of the upper aerodigestive tract: evaluation of the evidence for modifications of neck dissection. Head Neck 2001; 23:907–15PubMedCrossRef

26.

Samant S, Robbins T. Evolution of neck dissection for improved functional outcome. World J Surg 2003; 27:805–10PubMedCrossRef

27.

Bradford CR. Selective neck dissection is a option for early node-positive disease. Arch Otolaryngol Head Neck Surg 2004; 130:1436PubMedCrossRef

28.

Corry J, Smith JG, Peters LJ. The concept of planned neck dissection is obsolete. Cancer J 2001; 7:472–74PubMed

29.

McHam SA, Adelstein DJ, Rybicki LA, et al. Who merits a neck dissection after definitive chemoradiotherapy for N2–N3 squamous cell head and neck cancer? Head Neck 2003; 25:791–8PubMedCrossRef

30.

Pellitteri PK, Ferlito A, Rinaldo A, et al. Planned neck dissection following chemoradiotherapy for advanced head and neck cancer: is it necessary for all? Head Neck 2006; 28:166–75PubMedCrossRef

31.

Richards BL, Spiro JD. Controlling advanced neck disease: efficacy of neck dissection and radiotherapy. Laryngoscope 2000; 110:1124–7PubMedCrossRef

32.

Clark J, Li W, Smith G, et al. Outcome of treatment for advanced cervical metastatic squamous cell carcinoma. Head Neck 2005; 27:87–94PubMedCrossRef

33.

Mastronikolis NS, Fitzgerald D, Owen C, et al. The management of squamous cell carcinoma of the neck. The Birmingham UK experience. Eur J Surg Oncol 2005; 31:461–6PubMedCrossRef

Title: Preservation of the Internal Jugular Vein in the Radical Treatment of Node-Positive Neck—Is It Safe?
Authors: Everton Pontes Martins, MD
João Gonçalves Filho, MD, PhD
Ivan Marcelo Gonçalves Agra, MD
André Lopes Carvalho, MD, PhD
José Magrin, MD, PhD
Luiz Paulo Kowalski, MD, PhD
Publication date: 01-01-2008
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 1/2008
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-007-9680-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Preservation of the Internal Jugular Vein in the Radical Treatment of Node-Positive Neck—Is It Safe?

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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