who are the low-risk patients that could benefit from watch-and-wait regarding the neck?

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Abstract
CONTEXT AND OBJECTIVE: The management of clinically negative neck is controversial, with an ongoing debate on the indication criteria and prognostic impact of different types of therapy. The aim here was to compare the results from neck dissection and watch-and-wait, among oral cancer patients who, clinically, did not show any evidence of neck metastasis. DESIGN AND SETTING: Retrospective analysis in a tertiary cancer center hospital. METHODS: Patients with epidermoid oral carcinoma were assessed. The inclusion criteria were: primary tumor restricted to the oral/oropharyngeal cavity, no previous treatment, surgical treatment as the first option, clinical/radiological stage N0 and no distant metastasis. RESULTS: Two hundred and sixty-two patients were analyzed. The length of follow-up ranged from four to 369.6 months and, at the end, 118 patients were alive, 53 had died due to cancer, 84 had died from other causes and 7 had died after the operation. Among the patients who underwent neck dissection, lymphatic vascular embolization (P = 0.009) and tumor thickness (P = 0.002) were significant for regional recurrence, while for the watch-and-wait group, only tumor thickness was significant (P = 0.018). Through recursive partitioning, the patients without adverse prognostic factors and tumor thickness < 2 mm presented compatible results in the two groups. CONCLUSION: Elective neck dissection seems to be the best treatment option. Patients who are eligible for watch-and-wait constitute a small group that, ideally, is categorized according to the postoperative pathological findings
KONTEKS DAN TUJUAN: Penatalaksanaan leher yang secara klinis negatif masih kontroversial, dengan perdebatan yang terus berlanjut mengenai kriteria indikasi dan dampak prognostik dari berbagai jenis terapi. Tujuan dari penelitian ini adalah untuk membandingkan hasil antara diseksi leher dan pendekatan *watch-and-wait*, pada pasien kanker rongga mulut yang secara klinis tidak menunjukkan bukti metastasis leher. DESAIN DAN TEMPAT: Analisis retrospektif di rumah sakit pusat kanker tersier. METODE: Pasien dengan karsinoma epidermoid rongga mulut dievaluasi. Kriteria inklusi meliputi: tumor primer terbatas pada rongga mulut/orofaring, belum pernah menerima terapi sebelumnya, tindakan bedah sebagai pilihan terapi pertama, stadium klinis/radiologis N0, dan tidak ada metastasis jauh. HASIL: Sebanyak dua ratus enam puluh dua pasien dianalisis. Durasi pemantauan berkisar antara empat hingga 369,6 bulan dan, pada akhir periode penelitian, 118 pasien masih hidup, 53 meninggal akibat kanker, 84 meninggal karena penyebab lain, dan 7 meninggal pascaoperasi. Di antara pasien yang menjalani diseksi leher, embolisasi vaskular limfatik (P = 0,009) dan ketebalan tumor (P = 0,002) bermakna secara signifikan terhadap kekambuhan regional, sedangkan pada kelompok *watch-and-wait*, hanya ketebalan tumor yang bermakna signifikan (P = 0,018). Melalui pemartisian rekursif (*recursive partitioning*), pasien tanpa faktor prognostik yang merugikan dan ketebalan tumor < 2 mm menunjukkan hasil yang sebanding di kedua kelompok. KESIMPULAN: Diseksi leher elektif tampaknya merupakan pilihan terapi terbaik. Pasien yang memenuhi syarat untuk pendekatan *watch-and-wait* mencakup kelompok kecil yang, idealnya, dikategorikan berdasarkan temuan patologis pascaoperasi.
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Authors ;Hugo Fontan Kohler;Luiz Paulo Kowalski
Journal environmental management
Year Year not found
DOI
10.1590/S1516-31802011000500002
URL
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31802011000500002&lng=en&tlng=en
Keywords
neck dissection surgical procedures mouth neoplasms head and neck neoplasms

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