Neck dissection; evolution in the last two decades Shejbal D, Alerić Z, Barač I, Odobašić Ž, Zurak K, Šimunjak B, Bedeković V, Ivkić M. Klinika za ORL i cervikofacijalnu kirurgiju Medicinskog i Stomatološkog fakulteta Sveučilišta u Zagrebu KB “Sestre milosrdnice” Zagreb
Evolution of the neck dissection in last two decades
Jul 02, 2015
Evolution of the neck dissection
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Neck dissection; evolution in the last two decades
Shejbal D, Alerić Z, Barač I, Odobašić Ž, Zurak K, Šimunjak B, Bedeković V, Ivkić M.
Klinika za ORL i cervikofacijalnu kirurgiju Medicinskog i Stomatološkog fakulteta Sveučilišta u Zagrebu
KB “Sestre milosrdnice” Zagreb
INTRODUCTION
• 1906. Crile – “ en block” resekcion, first step to increase cancer head and neck mortality
• Carcinoma metastasis depends of tumor location – Mapping lymph drainage
• 1950. Suarez i Ballantyne introduce selective methods of dissection– Aim was increasing the same efficiency and
surviving rate and achieve less morbidity
CLASSIFICATION• American Academy of
Otolaryngology Head and Neck Surgery, 1991.
• THE RADICAL NECK DISSECTION
• MODIFIED RADICAL NECK DISSECTION
• SELECTIVE NECK DISSECTION
• EXTENDED NECK DISSECTION
AIM• SECURE TYPE AND NUMBER
OF DISSECTION
• DINAMICS OF INDICATION IN LAST TWO DECADES
• CHANGE OF ATTITUDE RECFLECTED ON TUMOR POSSITION AND MAKE DISSECTION
Data 1982 – 2001, ENT dep, KB “Sestre milosrdnice” Zagreb
METHODS
• Patient sqwamous cell carcinoma
• Location of primary tumor
• Other data: time of procedure, age, sex, surgeon
• I 82-91, II 92-01
DIFFICULTIES IN 80- ies
• DIFFERENCES IN TERMINOLOGY
• UNDEFINED AND GENERALISED DIAGNOSIS
• LACK OF DOCUMENTATION
• THE NEED TO COMBINE AND GROUP DATA
DOCUMENTATION EXAMPLE IN
90-IES
DOCUMENTATION EXAMPLE IN
90-IES
0
20
40
60
80
100
120
140
160
180
82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 0 1
MAIN NUMBER OF TREATED PATIENTS 2300
0
10
20
30
40
50
60
82-91 92-O1
DCR %
DCS %
DCRM %
OBOSTR. %
DISSECTION
No. 692 No. 932
0
20
40
60
80
100
120
82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 0 1
LARYNGECTOMY DISSECTION
LARYNGECTOMY WITH DISSECTION
0
102030405060708090
100
82-91 92-O1
UK. DIS. %DCR %DCS %DCRM %OBOSTR.
SUPRAGLOTTIC TUMORS, FREQUENCY AND TYPE OF DISSECTION
No. 49 No. 79
0
10
20
30
40
50
60
70
82-91 92-O1
UK.DIS. %
DCR %
DCS %
DCRM %
OBOSTR
No. 631 No. 373
GLOTTIC, TRANSGLOTTIC AND SUBGLOTTC TUMORSDISSECTION
CONCLUSIONS• strict acceptance of aknowledgements about tumor
methastasis• presurgical “staging”• Precise methods of surgical and patohistological
follow-up head and neck tumors• Systemized nomenclature• Increased number of elective dissection• Increased number of bilateral dissection• Decreased number of elective dissection• Decreased number of postsurgical irradiation
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