- Email: [email protected]
T2 N0 oral cavity SCC
Abstracts / Oral Oncology 47 (2011) S28–S73
O114. Initial results with sentinel lymph node biopsy for T1/T2 N0 oral cavity SCC A.L. Carvalho *, E.T. Rocha, R.C. Capuzzo, D.B. Junior, C.R. Santos, C.S. Neto Barretos Cancer Hospital, Brazil Introduction: The use of sentinel lymph node biopsy for T1/T2 N0 of SCC oral cavity have been describe as feasible and reliable to correctly stage the neck, however its use as a substitute to selective neck dissection for staging the neck in the clinical practice is still controversial. The objective of this study is to describe our initial results of sentinel lymph node biopsy for T1/T2 N0 oral cavity SCC. Methods: This study selected patients with for T1/T2 N0 of SCC oral cavity eligible to undergo sentinel lymph node biopsy. Twenty patients were included. 99mTc was injected peritumor previously to the procedure and the intraoperative mapping using a gamma detector was performed to localize sentinel nodes. Sentinel lymph nodes were pathological assessed by H&E and IHC. Cases with negative sentinel lymph node were only clinically followed and those with positive nodes underwent neck dissection. Results: The majority of the patients were male (80.0%), median age was 56 years. Tongue was the most common site in 55.0% of the cases. There were 14 cases staged as T1 (70.0%) and 6, T2 (30.0%). Occult metastasis was detected in 20% of the cases. During a mean follow-up of 10 months there were 2 neck recurrences (10%), one of them in a false negative sentinel lymph node (5%). Both cases underwent salvage neck dissection. Discussion: The sentinel lymph node biopsy procedure can accurately stage the neck in 95% of the cases, it presented low rates of neck failure and prevented 80% of the cases to undergo unnecessary neck dissection. This procedure should be considered for selected SCC oral cavity cases. doi:10.1016/j.oraloncology.2011.06.225
O115. Cervical metastasis of squamous cell carcinoma of the maxilla: A retrospective analysis of 50 cases M. Potter *, A. Kalantzis, R. Anand, S. Bond, S. Watt-Smith Department of Oral and Maxillofacial Surgery, The John Radcliffe Hospital, Oxford, UK Introduction: The aim of this study was to investigate the need for neck dissection in the treatment of squamous cell carcinoma of the maxilla. Methods: Fifty patients with SCC of the maxillary alveolus and palate were treated in a single unit between 2000 and 2010. Data related to cervical metastasis was collected retrospectively and related to T stage, histological grade and depth of invasion. Results: Of the 9 therapeutic neck dissections performed, 6 yielded positive lymph nodes (12% cN+), 15 patients has prophylactic neck dissections, 5 of which yielded positive nodes. Of the remaining 26 patients, for whom a ‘‘watchful waiting’’ policy was adopted, 6 developed cervical metastasis, all within the first year and in the absence of local recurrence. Overall, 11 patients (22%) had occult neck disease. Levels I, II, III and IV were involved in 14%, 14%, 16% and 2%, respectively. There were no metastasis to level V. Necks were positive in 14 of the 34 T3/4 tumours (41%), compared to 3 of the 16 T1/2 tumours (19%). All 16 positive necks were associated with primaries demonstrating >4 mm of invasion. None of the 10 tumours with depth of invasion up to 4 mm developed cervical metastasis. Neck disease was not associated with histological grade.
S67
Discussion: In our study 34% of patients with maxillary SCC developed cervical metastasis. The high proportion of occult neck disease (22%) would support elective neck dissection in patients with advanced disease (T3/4 and depth of invasion >4 mm). doi:10.1016/j.oraloncology.2011.06.226
O116. Transoral robotic resection of huge parapharyngeal and hypopharyngeal mass Y.-W. Koh *,a, S.-Y. Lee a, C.-H. Kim b, W.-S. Kim a, H.-S. Lee a, E.-C. Choi a a
Department of Otorhinolaryngology, Yonsei University College of Medicine, Republic of Korea b Department of Otolaryngology, Ajou University School of Medicine, Republic of Korea Introduction: Conventionally, huge parapharyngeal or hypopharyngeal mass excision requires a cervical collar incision or cervicoparotid incision and leaves a scar in what is deemed to be a cosmetically undesirable location. Technological advances, especially the introduction of endoscope and surgical robotic system, have brought in great change in surgery. We applied the robotic system to the resection of huge parapharyngeal and hypopharyngeal mass. Method and results: Two patients underwent transoral robotic resection of huge parapharyngeal and hypopharyngeal mass. A 19year-old male patient visited our institution because of left side palpable neck mass for several months. Neck computed tomography (CT) scan revealed a 6 cm-sized homogenous mass in parapharyngeal space. Fine needle aspiration biopsy (FNAB) suggested neurogenic tumor. Under the impression of neurogenic tumor, transoral robotic resection was performed. Another 53-year-old-male patient presented with recurrent hypopharyngeal lipoma. He have undergone two times laryngoscopic operations because of recurrence of lipoma. A 5 cm-sized well-defined low density mass in the right hypopharynx was found on the neck CT scan. We excised the recurrent lipoma via the same transoral robotic approach. The mass was pathologically diagnosed as an lipoma. We successfully finished both operations without any complications. The patients were discharged on post-operative day three and two, respectively. At a follow-up visit after discharge, both patients were completely satisfactory with the cosmetic outcome of the surgery. Conclusion: Our results demonstrate the feasibility of robot-assisted transoral resection of huge parapharyngeal and hypopharyngeal mass. The results suggest that transoral robotic resection could be a good substitute for conventional transcervical excision in selected parapharyngeal and hypopharyngeal mass. doi:10.1016/j.oraloncology.2011.06.227
O117. Results of salvage surgery for recurrent carcinoma of tongue L.Y. Chow *, Y.W. Chan, W.I. Wei Queen Mary Hospital, The University of Hong Kong, Hong Kong Introduction: This study aims to report our experience in the management of recurrent carcinoma of tongue (rCa Tongue) in our centre between 1999 and 2010. Methods: A retrospective review of all patients who underwent salvage surgery for rCa tongue in a tertiary centre between 1999 and 2010. Outcome measures included patient demographics, stage
O114. Initial results with sentinel lymph node biopsy for T1/T2 N0 oral cavity SCC A.L. Carvalho *, E.T. Rocha, R.C. Capuzzo, D.B. Junior, C.R. Santos, C.S. Neto Barretos Cancer Hospital, Brazil Introduction: The use of sentinel lymph node biopsy for T1/T2 N0 of SCC oral cavity have been describe as feasible and reliable to correctly stage the neck, however its use as a substitute to selective neck dissection for staging the neck in the clinical practice is still controversial. The objective of this study is to describe our initial results of sentinel lymph node biopsy for T1/T2 N0 oral cavity SCC. Methods: This study selected patients with for T1/T2 N0 of SCC oral cavity eligible to undergo sentinel lymph node biopsy. Twenty patients were included. 99mTc was injected peritumor previously to the procedure and the intraoperative mapping using a gamma detector was performed to localize sentinel nodes. Sentinel lymph nodes were pathological assessed by H&E and IHC. Cases with negative sentinel lymph node were only clinically followed and those with positive nodes underwent neck dissection. Results: The majority of the patients were male (80.0%), median age was 56 years. Tongue was the most common site in 55.0% of the cases. There were 14 cases staged as T1 (70.0%) and 6, T2 (30.0%). Occult metastasis was detected in 20% of the cases. During a mean follow-up of 10 months there were 2 neck recurrences (10%), one of them in a false negative sentinel lymph node (5%). Both cases underwent salvage neck dissection. Discussion: The sentinel lymph node biopsy procedure can accurately stage the neck in 95% of the cases, it presented low rates of neck failure and prevented 80% of the cases to undergo unnecessary neck dissection. This procedure should be considered for selected SCC oral cavity cases. doi:10.1016/j.oraloncology.2011.06.225
O115. Cervical metastasis of squamous cell carcinoma of the maxilla: A retrospective analysis of 50 cases M. Potter *, A. Kalantzis, R. Anand, S. Bond, S. Watt-Smith Department of Oral and Maxillofacial Surgery, The John Radcliffe Hospital, Oxford, UK Introduction: The aim of this study was to investigate the need for neck dissection in the treatment of squamous cell carcinoma of the maxilla. Methods: Fifty patients with SCC of the maxillary alveolus and palate were treated in a single unit between 2000 and 2010. Data related to cervical metastasis was collected retrospectively and related to T stage, histological grade and depth of invasion. Results: Of the 9 therapeutic neck dissections performed, 6 yielded positive lymph nodes (12% cN+), 15 patients has prophylactic neck dissections, 5 of which yielded positive nodes. Of the remaining 26 patients, for whom a ‘‘watchful waiting’’ policy was adopted, 6 developed cervical metastasis, all within the first year and in the absence of local recurrence. Overall, 11 patients (22%) had occult neck disease. Levels I, II, III and IV were involved in 14%, 14%, 16% and 2%, respectively. There were no metastasis to level V. Necks were positive in 14 of the 34 T3/4 tumours (41%), compared to 3 of the 16 T1/2 tumours (19%). All 16 positive necks were associated with primaries demonstrating >4 mm of invasion. None of the 10 tumours with depth of invasion up to 4 mm developed cervical metastasis. Neck disease was not associated with histological grade.
S67
Discussion: In our study 34% of patients with maxillary SCC developed cervical metastasis. The high proportion of occult neck disease (22%) would support elective neck dissection in patients with advanced disease (T3/4 and depth of invasion >4 mm). doi:10.1016/j.oraloncology.2011.06.226
O116. Transoral robotic resection of huge parapharyngeal and hypopharyngeal mass Y.-W. Koh *,a, S.-Y. Lee a, C.-H. Kim b, W.-S. Kim a, H.-S. Lee a, E.-C. Choi a a
Department of Otorhinolaryngology, Yonsei University College of Medicine, Republic of Korea b Department of Otolaryngology, Ajou University School of Medicine, Republic of Korea Introduction: Conventionally, huge parapharyngeal or hypopharyngeal mass excision requires a cervical collar incision or cervicoparotid incision and leaves a scar in what is deemed to be a cosmetically undesirable location. Technological advances, especially the introduction of endoscope and surgical robotic system, have brought in great change in surgery. We applied the robotic system to the resection of huge parapharyngeal and hypopharyngeal mass. Method and results: Two patients underwent transoral robotic resection of huge parapharyngeal and hypopharyngeal mass. A 19year-old male patient visited our institution because of left side palpable neck mass for several months. Neck computed tomography (CT) scan revealed a 6 cm-sized homogenous mass in parapharyngeal space. Fine needle aspiration biopsy (FNAB) suggested neurogenic tumor. Under the impression of neurogenic tumor, transoral robotic resection was performed. Another 53-year-old-male patient presented with recurrent hypopharyngeal lipoma. He have undergone two times laryngoscopic operations because of recurrence of lipoma. A 5 cm-sized well-defined low density mass in the right hypopharynx was found on the neck CT scan. We excised the recurrent lipoma via the same transoral robotic approach. The mass was pathologically diagnosed as an lipoma. We successfully finished both operations without any complications. The patients were discharged on post-operative day three and two, respectively. At a follow-up visit after discharge, both patients were completely satisfactory with the cosmetic outcome of the surgery. Conclusion: Our results demonstrate the feasibility of robot-assisted transoral resection of huge parapharyngeal and hypopharyngeal mass. The results suggest that transoral robotic resection could be a good substitute for conventional transcervical excision in selected parapharyngeal and hypopharyngeal mass. doi:10.1016/j.oraloncology.2011.06.227
O117. Results of salvage surgery for recurrent carcinoma of tongue L.Y. Chow *, Y.W. Chan, W.I. Wei Queen Mary Hospital, The University of Hong Kong, Hong Kong Introduction: This study aims to report our experience in the management of recurrent carcinoma of tongue (rCa Tongue) in our centre between 1999 and 2010. Methods: A retrospective review of all patients who underwent salvage surgery for rCa tongue in a tertiary centre between 1999 and 2010. Outcome measures included patient demographics, stage