Pattern of spread of carvical node metastases. Assessment of a technique of segmented neck dissection that allows for severance of soft tissues.:ASSESSMENT OF A TECHNIQUE OF SEGMENTED NECK DISSECTION THAT ALLOWS FOR SEVERANCE OF SOFT TISSUES

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The aim of this study is to assess the safety of a neck dissection in which the fat pad was servered in certain areas deliberately in order to be removed as divided spaces instead of a standard en bloc manner. This surgical approach was applied to three patients with head and neck squamous cell carcinoma staged N2b. The cervical fat pad was divided into three compartments separeted anteriorly by the internal jugular vein and posteriorly by the spinal accesory nerve. Each compartment was dissected free from the other ones. The fat pad thus removed, consisting of 9 separatic speciments, were serially sectioned in the direction vertical to the lymphatic flow so that the extent of tumor cell spread could be traced in the lymphatics. There were 11 lymphnodes that contained metastatic disease in the 9 specimens examined. Of the 11 positive nodes, seven showed an evidence of tumor cells in the lymphatic duct adjacent to the capsule of these nodes. However, no tumor cell infiltration was found in the lymphatic duct located far from the nodes involved with metastases. The observaation suggests that the possibility of tumor dissemination seems to be unaffected by this surgical approach that allows for division of lymph node bearing fat pad. In the presence of metastatic nodal disease, this surgical technique may be safely employed, propvided the capsule of the nodes that contain metastatic disease remains surgically intact.
日本頭頸部癌学会の論文