Preservación de la glándula submandibular en las disecciones linfonodulares de cuello
11 May 2015-Vol. 52, Iss: 3, pp 61-77
TL;DR: Los estudios coinciden en el bajo riesgo de metastasis ocultas a the glandula por carcinomas escamosos de cabeza y cuello, xerostomia post-quirurgica y factibilidad of the tecnica quirurgica como fundamentos para preservar the submandibular.
Abstract: Introduccion: El desarrollo acelerado de la Oncologia ha condicionado recientes modificaciones terapeuticas que pudieran incluir la preservacion de la glandula submandibular en las disecciones de cuello. Objetivos : identificar los criterios para preservar quirurgicamente la glandula submandibular y exponer los fundamentos cientifico-teoricos que permitan plantear una modificacion actual a la tecnica de diseccion de cuello al conservar dicha glandula. Metodo : se realizo una busqueda exhaustiva retrospectiva de articulos publicados en las bases de datos electronicas PUBMED, MEDLINE, COCHRANE e HINARI desde Enero 2009 hasta Julio de 2014; en las revistas Head and Neck , Otolaryngology and Head and Neck Surgery y The Laryngoscope c on los terminos: “preservacion glandula submandibular”, “criterios oncologicos conservar glandula submandibular”, “modificaciones disecciones linfonodulares cervicales”, sin restricciones idiomaticas. Ademas de cumplir con estos requisitos se incluyeron solo los articulos cuyo material y metodo reflejara: estudios poblacionales, disecciones de cuello como tratamiento oncoespecifico y confirmacion anatomo-patologica para concluir el diagnostico. Fecha de publicacion: ultimos 5 anos. Resultados : de 3 estudios que conformaron una meta-poblacion de 829 pacientes, donde se preservo la glandula submandibular en un grupo de pacientes con tumores de cavidad bucal y orofaringe y disecciones de cuello simultaneas, se evidencio que no hubo diferencias en cuanto a recaida local, regional, a distancia ni sobrevida al compararlos con otro grupo de pacientes donde la diseccion de cuello no incluyo este proceder. Conclusion : los estudios coinciden en el bajo riesgo de metastasis ocultas a la glandula por carcinomas escamosos de cabeza y cuello, xerostomia post-quirurgica y factibilidad de la tecnica quirurgica como fundamentos para preservar la submandibular, de igual manera en que la ausencia de terapia oncoespecifica anterior, linfonodulos positivos en el subnivel IB y relacion entre el tumor primario y la glandula son criterios necesarios en la seleccion de candidatos para llevar a cabo este proceder.
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01 Jan 2013
TL;DR: The authors investigated and analyzed the retrospective charts of 236 patients who underwent surgery for OCSCC over a 10-year period and the pathology reports of 294 neck dissections with SMG removal to determine the frequency and the mechanism of submandibular gland involvement in oral cavity squamous cell carcinomas.
Abstract: SUMMAry The aim of this study was to determine the frequency and the mechanism of submandibular gland (SMg) involvement in oral cavity squamous cell carcinomas (oCSCC), and to discuss the necessity of extirpation of the gland. The authors investigated and analyzed the retrospective charts of 236 patients who underwent surgery for oCSCC over a 10-year period and the pathology reports of 294 neck dissections with SMg removal. SMg involvement was evident in 13 cases (4%). Eight cases were due to direct invasion, which was the most common mechanism. Four cases had infiltration from a metastatic periglandular lymphadenopathy, and in 1 case, metastatic disease was confirmed. The tongue and floor of the mouth were the most frequent primary sites associated with SMg involvement. The study found no bilateral cases, and in 135 SMg specimens benign pathologies were detected. involvement of the SMg in oCSCC is not frequent. it is appropriate to preserve the gland unless the primary tumour or metastatic regional lymphadenopathy is adherent to the gland.
27 citations
References
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TL;DR: ROC-analysis on pT1cN0 tumours resulted in an optimal cut-off for the prediction of the nodal status at a depth of 4.59 mm, identified a subgroup of patients at increased risk for nodal metastasis and with significantly shorter survival.
99 citations
TL;DR: Decision analysis was used to determine the current optimal strategy in comparison with observation of the neck and elective neck dissection and proper calculation of three probabilities of being cured in each institution will make a decision of the optimal method of clinical N0 neck.
91 citations
TL;DR: The inclusion of information about ECS in the neck dissection improved the prognostic classification of patients with HNSCC in relation to the pTNM classification, and the RPA-derived classification achieved a better prognostic discrimination than the pN+/ECS+ classification.
Abstract: Importance: The inclusion of data about the presence ofmetastaticnecknodeswithextracapsularspread(ECS) in the neck dissection improves the prognostic classification of patients with head and neck squamous cell carcinoma (HNSCC). Objective: To evaluate the prognostic capacity of ECS in patients with HNSCC, and to analyze the usefulness of including this information in the pathological classification of patients treated with a neck dissection. Design: Retrospective unicenter study performed from 1985 through 2007. Setting: Tertiary referral center. Participants: A total of 1190 patients with HNSCC treated with a neck dissection. Intervention: Unilateral or bilateral neck dissection. Main Outcomes and Measures: Adjusted survival and local, regional, and distant metastases-free survival. Patients were classified according to a recursive partitioning analysis (RPA) method, considering pN category and number of neck nodes with ECS as the independent variables. Results: Five-year adjusted survival for patients without metastatic nodes in the neck dissection (pN0) was 85.5%, forpatientswithnecknodemetastaseswithoutECS(pN/ ECS) it was 62.5%, and for patients with neck node metastases with ECS (pN/ECS) it was 29.9%. There were significantdifferencesinsurvivalbetweenpatientswithpN0 lesions and pN/ECS (P.001), and between patients with pN/ECS and those with pN/ECS (P.001). According to the RPA method, we propose classifying patients according to 4 categories: category I, pN0 lesions; category II, pN1/ECSor pN/ECS; category III, pN23/1 node and ECS; and category IV, pN2-3/2 or more nodesandECS.TheRPA-derivedclassificationachieved a better prognostic discrimination than the pTNM classification. Conclusions and Relevance: The inclusion of information about ECS in the neck dissection improved the prognostic classification of patients with HNSCC in relation to the pTNM classification.
89 citations
01 Jan 2010
TL;DR: Based on the major advances made in the field of stem cell research, stem cell-based therapy has great potential to allow prevention or treatment of radiation-induced hyposalivation.
Abstract: Hyposalivation underlying xerostomia after radiotherapy is still a major problem in the treatment of head and neck cancer. Stem cell therapy may provide a means to reduce radiation-induced hyposalivation and improve the quality of life of patients. This review discusses the current status in salivary gland stem cell research with respect to their potential to attenuate salivary gland dysfunction. Knowledge on the embryonic development, homeostasis and regeneration after atrophy of the salivary glands has provided important knowledge on the location of the salivary gland as well as on the factors that influence proliferation and differentiation. This knowledge has helped to locate, isolate and characterize cell populations that contain the salivary gland stem cell, although the exact tissue stem cell is still unidentified. The role that stem Uprogenitor cells play in the response to radiation and the factors that can influence stem Uprogenitor induced proliferation and differentiation are discussed. Finally, the mobilization and transplantation of stem cells and supportive cells and their potential to attenuate radiation-induced salivary gland damage are discussed. Based on the major advances made in the field of stem cell research, stem cell-based therapy has great potential to allow prevention or treatment of radiation-induced hyposalivation.
88 citations
Journal Article•
TL;DR: Transplantation of autologous salivary glands to the lacrimal basin has been performed in patients with severexerophthalmos and with or without severe xerostomia, resulting in 2 relative successes.
Abstract: Transplantation of autologous salivary glands to the lacrimal basin has been performed in patients with severe xerophthalmos and with or without severe xerostomia. In five cases a free transplantation of the sublingual salivary gland was performed obtaining only one relative success. In 3 cases a transplant of the submaxillary gland was performed with maintained blood supply through vascular anastomosis, resulting in 2 relative successes.
87 citations