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Extent of lymph node dissection in T3/T4 cancer of the alveolo-buccal complex
R S Rao1, V H Deshmane, H K Parikh
1Department of Surgery, Tata Memorial Hospital, Bombay, India.
Background:
Cancer of the alveolo-buccal complex even when locally advanced is amenable to curative resection. However, the extent of lymph node dissection remains controversial.
Methods:
A total of 181 patients with T3/T4 cancer of the alveolo-buccal complex who underwent a radical neck dissection (RND) were analyzed retrospectively to determine the incidence and pattern of lymph node involvement and to define the extent of neck dissection required in these cancers.
Results:
Lymph node involvement was as follows: level I (85%), II (51%), III (19%), IV (18%), V (5%). Levels I and II were most commonly involved (94%). Skip metastases occurred in 13%. Levels IV and V were involved in 2% and 20% when levels I, II, and III were uninvolved and involved, respectively.
Conclusion:
A supraomohyoid neck dissection (SOHD) should be performed and subjected to a frozen section evaluation in every patient. If lymph nodes are negative, then SOHD is adequate. If levels I, II, or III are positive, then a RND should be performed.