JOMS study: Elective neck surgery can improve outcomes for patients with rare oral cancer
March 12, 2019
ROSEMONT, Ill. – Elective surgery that removes lymph nodes from the neck is effective in treating patients with a type of aggressive oral cancer, resulting in improved survival rates and reduced rates for the cancer reoccurring in the same area or spreading to a different site, according to a study published in the March issue of the Journal of Oral and Maxillofacial Surgery.
Buccal squamous cell carcinoma (BSCC) is an aggressive but rare cancer that starts in the cheek lining in the mouth. The cancer has high rates of reoccurring in the same area, known as locoregional recurrence. No model treatment for the cancer with clinically negative neck findings (N0) – without questionable neck lymph nodes – has been determined, according to researchers.
The study published in the official journal of the American Association of Oral and Maxillofacial Surgeons (AAOMS) explored whether elective neck dissection (END) – which involves cutting whole groups of lymph nodes from the neck without confirmation of cancer in the neck – would improve patient outcomes.
The retrospective cohort study involved patients treated for the cancer at the University of Washington, University of Michigan, University of Tennessee, North Memorial Oral and Maxillofacial Surgery in Robbinsdale, Minn., University of Minnesota and Head and Neck Surgical Associates in Portland, Ore. Of the 98 patients who had the cancer with the inner cheek lining (buccal mucosa) as the primary site, 76 percent underwent END for primary therapy.
The results revealed “significant” differences in terms of survival rates and rates of cancer reoccurrence in the area and spreading depending on whether the patient underwent END, suggesting END “may improve clinical outcomes for patients” with BSCC with clinically negative neck findings, according to the study.
The locoregional recurrence-free rate – the probability of staying recurrence-free for two years – was 61 percent for the surgery compared to 38 percent without the surgery. The distant metastasis rate – the rate the cancer spread from the original tumor to distant organs or lymph nodes – was 4 percent for END patients and 9 percent for those without END. For END, the two- and five-year disease-free survival rates were 91 percent and 75 percent, respectively. Without END, the rates were 85 percent and 63 percent, respectively.
The researchers concluded: “Our data indicate that END improves clinical outcomes for patients with clinical N0 BSCC and should be an important consideration in treatment planning.”
The authors of “What Is the Role of Elective Neck Dissection in the Management of Patients With Buccal Squamous Cell Carcinoma and Clinically Negative Neck Findings?” are: Jasjit K. Dillon, MBBS, DDS (University of Washington), Akashdeep S. Villing, DMD (private practice), Richard S. Jones, DDS (private practice), Neal D. Futran, MD, DMD (University of Washington), Hans C. Brockhoff II, MD, DDS (University Medical Center, El Paso, Texas), Eric R. Carlson, MD, DMD (University of Tennessee), Thomas Schlieve, MD, DDS (University of Texas Southwestern/Parkland Memorial Hospital), Deepak Kademani, MD, DMD (North Memorial Oral and Maxillofacial Surgery), Ketan Patel, DDS, PhD (North Memorial Oral and Maxillofacial Surgery), Scott T. Claiborne, MD, DDS (North Memorial Oral and Maxillofacial Surgery), Eric J. Dierks,MD, DMD (Emmanuel Hospital, Portland, Ore.), Yedeh P. Ying, MD, DMD (University of Alabama), and Brent B. Ward, MD, DDS (University of Michigan).
The full article can be accessed at www.JOMS.org/article/S0278-2391(18)31200-X/fulltext.
The Journal of Oral and Maxillofacial Surgery is published by the American Association of Oral and Maxillofacial Surgeons to present to the dental and medical communities comprehensive coverage of new techniques, important developments and innovative ideas in oral and maxillofacial surgery. Practice-applicable articles help develop the methods used to handle dentoalveolar surgery, facial injuries and deformities, TMJ disorders, oral and head and neck cancer, jaw reconstruction, anesthesia and analgesia. The journal also includes specifics on new instruments and diagnostic equipment, and modern therapeutic drugs and devices.