• Journal of Chest Surgery
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• v.28 no.10
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• pp.954-962
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• 1995

Extended lymph node dissection, which includes dissection of the cervical and superior mediastinal nodes[three-field dissection , has been performed to improve the long-term survival since 1982 in Japan. Recently, the 5-year survival rate after three-field dissection has been reported to be better than 40%. During the period, from April to June, 1995, 4 patients among 7 operable esophageal cancer patients underwent subtotal esophagectomy with systematic dissection of regional lymph nodes including superior mediastinal and cervical lymph nodes at St. Mary`s Hospital. The esophagogastric anastomoses were made in the neck and the ascending routes of gastric tube were posterior mediastinal route. The cancer stage of them were stage IIA & IIB and it was possible to operate on a curability II & III basis. The numbers of resected lymph nodes with the three field dissection were 40-55. Postoperative complications were transient recurrent laryngeal nerve paralysis and atelectasis in 2 patients respectively but there was no anastomotic leak nor stenosis.

• International journal of thyroidology
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• v.11 no.2
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• pp.117-122
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• 2018

Metastases to regional cervical lymph nodes occur frequently in patients with thyroid cancer. The appropriate management of regional lymph node is important to achieve good disease control and to classify risk stratification for adjuvant radioactive iodine. However, there are some occasions that neck dissection is difficult and embarrassing in thyroid cancer. Especially, extensive or unusual nodal metastases bring challenges and makes neck dissection more difficult. Carotid artery management is one of the most difficult procedure in neck dissection. The management of patients who have persistent or recurrent cervical metastasis involving the carotid artery has been controversial and treatment dilemma to the surgeon. Metastasis of well differentiated thyroid cancer to the retropharyngeal lymph nodes is rare but occasionally encountered. The complete surgical excision is usually recommended for retropharyngeal lymph node metastasis of well differentiated thyroid cancer. An extensive mediastinal dissection in advanced differentiated thyroid carcinoma is occasionally required. This paper will review recent reports of management of advanced nodal metastasis of thyroid cancer and share the author's personal experience.

• The Journal of the Korean dental association
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• v.48 no.8
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• pp.594-606
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• 2010

Lymph node status is the single most important prognostic factor in oral cancer because lymph node involvement decreases overall survival by 50%. Appropriate management of the regional lymphatics, therefore, plays a central role in the treatment of the oral cancer patients. The purposes of this article are to present the history of neck dissections, including current neck dissection classification, describe the technique of the most common neck dissection applicable to oral cavity cancers, and discuss some of the complications associated with neck dissection. Finally, a brief review of elective neck dissection and sentinel lymph node biopsy will be presented. It is necessary that dentists have to be interested in oral cancer and these interest will make it possible to prevent oral cancer, detect it earlier and also improve the prognosis, survival and the quality of life of survivors.

• Radiation Oncology Journal
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• v.37 no.1
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• pp.51-59
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• 2019

Purpose: We evaluated failure pattern and treatment outcomes of observational approach on regional lymph node (LN) in cutaneous melanoma of extremities and sought to find clinico-pathologic factors related to LN metastases. Material and Methods: We retrospectively reviewed 73 patients with cutaneous melanoma of extremities between 2005 and 2016. If preoperative 18-F-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) findings were non-specific for regional LNs, surgical resection of primary tumors with adequate margins was performed without sentinel lymph node biopsy (SLNB) and/or complete lymph node dissection (CLND), irrespective of tumor thickness or size. In patients with suspicious or positive findings on PET/CT or CT, SLNB followed by CLND or CLND was performed at the discretion of the surgeon. We defined LN dissection (LND) as SLNB and/or CLND. Results: With a median follow-up of 38 months (range, 6 to 138 months), the dominant pattern of failure was regional failure (17 of total 23 events, 74%) in the observation group (n = 56). Pathologic LN metastases were significant factor for poor regional failure-free survival (hazard ration [HR] = 3.21; 95% confidence interval [CI], 1.03-10.33; p = 0.044) and overall survival (HR = 3.62; 95% CI, 1.02-12.94; p = 0.047) in multivariate analysis. In subgroup analysis for cN0 patients according to the preoperative PET/CT findings, LND group showed the better trend of LRFFS (log rank test, p = 0.192) and RFFS (p = 0.310), although which is not statistically significant. Conclusion: Observational approach on regional LNs on the basis of the PET/CT in patients with cutaneous melanoma of extremities showed the dominant regional failure pattern compared to upfront LND approach. To reveal regional lymph node status, SLND for cN0 patients may of importance in managing cutaneous melanoma patients.

• The Korean Journal of Nuclear Medicine
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• v.33 no.3
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• pp.243-246
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• 1999

Currently, dissection of the axillary or regional lymph nodes is considered the standard staging procedure in breast cancer. However, accumulating evidence is becoming available that the sentinel node concept may provide the same or even better staging information. In the case of melanoma, it is proven that the histological characteristics of the sentinel node reflect the histological characteristics of the distal part of the lymphatic basin. Morbidity can be reduced significantly by the use of sentinel node dissection as several authors have reported successful introduction of this technique into clinical practice. But in breast cancer patients, there are signigicant differences in practice relating to the technology, such as radiopharmaceuticals, injection sites, volume of injectate, combination with vital blue dye, preoperative lymphoscintigraphy, etc. Valuable reports on these topics appeared in recent journals. This review is a summary of those reports for nuclear physicians interested in sentinel node detection by lymphoscintigraphy in breast cancer patients.

• Korean Journal of Bronchoesophagology
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• v.6 no.2
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• pp.147-151
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• 2000

Background and Objectives： Metastasis to the submental and submandibular lymph nodes rarely occurs in squamous cell carcinoma of the larynx and hypopharynx. The aim of this study is to evaluate the effectiveness of level I neck dissection in squamous cell carcinoma of larynx and hypopharynx. Materials and Methods : Forty-three patients with pathologically positive cervical nodal involvement in squamous cell carcinoma of larynx and hypopharynx treated between 1989 to 1998 were reviewed. Fifteen patients were treated with neck dissection including level 1,28 patients were treated with neck dissection excluding the level 1. Results : The regional recurrence at the level I in patients treated with neck dissection excluding the level I, was shown in only one case (recurrence rate 3.6%), but this patient was efficiently managed with salvage operation and adjuvant radiotherapy. No recurrence was shown in patients treated with neck dissection including the level I. So, total recurrence rate at the level I was 2.3%. Conclusion : This study suggests that dissection of the level I is not justified in squamous cell carcinoma of larynx and hypopharynx even if metastasis to cervical lymph node was confirmed preoperatively (cN+).

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.41 no.6
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• pp.299-305
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• 2015

Objectives: This article describes our experience with neck dissection in 10 patients with oral squamous cell carcinoma. Materials and Methods: Between January 2007 and October 2009, 10 patients underwent primary surgery for the treatment of squamous cell carcinoma of the oral cavity. For patients with $N_0$ disease on clinical exam, selective neck dissection (SND [I-III]) was performed. In patients with palpable cervical metastases (N+), modified radical neck dissections were performed, except in one patient in whom SND (I-III) was performed. The histopathologic reports were reviewed to assess the surgical margins, the presence of extra-capsular spread, perineural invasion, and lymphatic invasion. Results: On histopathologic examination, positive soft tissue margins were found in three patients, and regional lymph node metastases were present in five of the ten patients. Perineural invasion was noted in five patients, and extra nodal spread was found in four patients. Regional recurrence was seen in two patients and loco-regional recurrence plus distant metastasis to the tibia was observed in one patient. During the study period, three patients died. Seven patients remain free of disease to date. Conclusion: Histopathological evaluation provides important and reliable information for disease staging, treatment planning, and prognosis. The philosophy of neck dissection is evolving rapidly with regard to the selectivity with which at-risk lymph node groups are removed. The sample size in the present study is small, thus, caution should be employed when interpreting these results.

• Journal of Gastric Cancer
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• v.20 no.4
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• pp.442-453
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• 2020

Purpose: Expanded indications for endoscopic submucosal dissection (ESD) in early gastric cancer (EGC) remain controversial due to the potential risk of undertreatment after adequate lymph node dissection (LND). Regional LND (RLND) is a novel technique used for limited lymphadenectomy to avoid gastrectomy. This study established the safety and effectiveness of RNLD as an additional treatment option after ESD for expanded indications. Materials and Methods: A total of 69 patients who met the expanded indications for ESD were prospectively enrolled from 2014 to 2017. The tumors were localized using intraoperative esophagogastroduodenoscopy (EGD) before RLND. All patients underwent RLND first, followed by conventional radical gastrectomy with LND. The locations of the preoperative and intraoperative EGD were compared. Pathologic findings of the primary lesion and the RLND status were analyzed. Results: The concordance rates of tumor location between the preoperative and intraoperative EGD were 79.7%, 76.8%, and 63.8% according to the longitudinal, circumferential, and regional locations, respectively. Of the 4 patients (5.7%) with metastatic LNs, 3 were pathologically classified as beyond the expanded indication for ESD and 1 had a single LN metastasis in the regional lymph node. Conclusions: RLND is a safe additional option for the treatment of EGC in patients meeting expanded indications after ESD.

• Radiation Oncology Journal
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• v.32 no.3
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• pp.132-137
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• 2014

Purpose: To evaluate non-sentinel lymph node (LN) status after sentinel lymph node biopsy (SNB) in patients with breast cancer and to identify the predictive factors for disease failure. Materials and Methods: From January 2006 to December 2007, axillary lymph node (ALN) dissection after SNB was performed for patients with primary invasive breast cancer who had no clinical evidence of LN metastasis. A total of 320 patients were treated with breast-conserving surgery and radiotherapy. Results: The median age of patients was 48 years, and the median follow-up time was 72.8 months. Close resection margin (RM) was observed in 13 patients. The median number of dissected SNB was two, and that of total retrieved ALNs was 11. Sentinel node accuracy was 94.7%, and the overall false negative rate (FNR) was 5.3%. Eleven patients experienced treatment failure. Local recurrence, regional LN recurrence, and distant metastasis were identified in 0.9%, 1.9%, and 2.8% of these patients, respectively. Sentinel LN status were not associated with locoregional recurrence (p > 0.05). Close RM was the only significant factor for disease-free survival (DFS) in univariate and multivariate analysis. The 5-year overall survival, DFS, and locoregional DFS were 100%, 96.8%, and 98.1%, respectively. Conclusion: In this study, SNB was performed with high accuracy and low FNR and high locoregional control was achieved.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.7
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• pp.4273-4278
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• 2013

Objective: We aimed to define clinicopathologic risk factors associated with regional recurrence (RR) and thus the effectiveness of postoperative radiotherapy (PORT) for neck control for head and neck squamous cell carcinomas (HNSCCs) with differing cervical lymph node status. Methods: A retrospective study was performed in 196 HNSCC patients with pathologically positive neck node (N+) to evaluate the high-risk factors for RR and to define the role of PORT in control after neck dissection and postoperative radiotherapy (PORT). Results: Overall, the RR rate after neck dissection and PORT was 29%. Extracapsular spread (ECS) was confirmed to be the only independent risk factor for RR. There were no significant risk factors associated with RR in the ECS- group. The 5-year disease-specific survival rate was 45%, which descended to 10% with the emergence of RR. Conclusions: ECS remains a determined risk factor for RR after neck dissection and PORT in patients with N+. PORT alone is not adequate for preventing RR in the neck with ECS after neck dissection. More intensive postoperative adjuvant therapies, especially combined chemotherapy and radiotherapy, are needed to prevent regional failure in HNSCC patients with ECS.