Influence of Nodal Yield in Individual Neck Dissection Levels on the Survival of Patients With Oral and Oropharyngeal Cancer

Ana Kvolik Pavić; Josip Butković; Vedran Zubčić; Zvonimir Popović; Dinko Leović*

doi:10.26332/seemedj.v4i1.120

Ana Kvolik Pavić Department of Maxillofacial and Oral Surgery, University Hospital Osijek, Croatia; Faculty of Medicine, J. J. Strossmayer University of Osijek, Croatia http://orcid.org/0000-0002-3991-6433
Josip Butković Department of Maxillofacial and Oral Surgery, University Hospital Osijek, Croatia; Faculty of Medicine, J. J. Strossmayer University of Osijek, Croatia
Vedran Zubčić Department of Maxillofacial and Oral Surgery, University Hospital Osijek, Croatia; Faculty of Medicine, J. J. Strossmayer University of Osijek, Croatia http://orcid.org/0000-0003-0338-6941
Zvonimir Popović Faculty of Medicine, J. J. Strossmayer University of Osijek, Croatia; Department of Neurology, University Hospital Osijek, Croatia http://orcid.org/0000-0003-3397-7726
Dinko Leović* Faculty of Medicine, J. J. Strossmayer University Osijek, Croatia; Department of ENT and head and neck surgery, University Hospital Centre Zagreb, Croatia; Faculty of Dental Medicine and Health, J. J. Strossmayer University Osijek, Croatia http://orcid.org/0000-0003-3644-8993

DOI: https://doi.org/10.26332/seemedj.v4i1.120

Abstract

Introduction: Nodal yield (NY), or the number of collected and analysed lymph nodes in neck dissection, is one of the variables that could supplement the existing TNM classification in order to better stratify patients and their needs for further treatment. The purpose of this paper was to investigate the importance of NY in individual neck dissection levels and its relation to survival.

Materials and methods: A retrospective analysis of medical records of 133 patients regarding primary tumour excision and neck dissection from 2002 to 2013. Seventy-nine patients had a neck dissection divided by levels at the time of surgery and 54 patients had an en bloc resection.

Results: In the group of all patients, there was no correlation between NY and survival. In the group of patients who underwent a selective neck dissection, a NY above the median was an indicator of a better disease-specific survival (5-year DSS < median NY 70.6%, > median NY 95.2%, p = 0.037 log-rank test). The NY of specimens separated by level was significantly higher than the NY of specimens analysed en bloc (median 33 vs 16; p < 0.001, median test). In the group of specimens separated by level, the NY in levels I-II was not associated with survival, but a high NY in levels III-IV in selective neck dissections was an indicator of an improved overall survival (p = 0.05), disease-specific survival (p = 0.022) and disease-free survival (p = 0.05).

Conclusion: High NY in patients with specimens separated by levels could be caused by a more precise pathohistological analysis of a smaller sample. A high NY in levels III-IV can be an indicator of a well-performed selective neck dissection and sufficiently treated regional disease and therefore lead to better survival rates.

(Kvolik A, Butković J, Zubčić V, Popović Z, Leović* D. Influence of Nodal Yield in Individual Neck Dissection Levels on Survival of Patients With Oral and Oropharyngeal Cancer, Comorbidity and Chronic Therapy. SEEMEDJ 2020; 4(1); 14-24)