World J Oral Maxillofac Surg | Volume 1, Issue 2 | Research Article | Open Access
Ashraf Messiha*, Martin Woods, Francine Ryba, Maria Pinzakoria, Nicholas Hyde and Graham Smith
Department of Oral and Maxillofacial Surgery, St George's Hospital, UK
*Correspondance to: Ashraf Messiha
Fulltext PDFObjective: To develop a protocol that can be utilised to audit and monitor performance of Head and Neck services. To determine whether the quantitative recovery of lymph nodes from the neck is dependent on operating surgeon, the type of neck dissection and effect of previous radiotherapy or chemo radiotherapy. The question is asked whether this data can be utilised to audit performance of head and neck services and to propose the number of nodes per level that would be considered adequate.
Methods: Retrospective analysis of data of 256 Neck Dissections (ND) from 210 patients with mucosal squamous cell carcinoma of the head and neck treated at St Georges Hospital between 2003 and 2007. Data were obtained for age, pre-operative TNM staging, surgeon, type of neck dissection, previous radiotherapy, previous chemo-radiotherapy, Total Nodal Yield per Neck Dissected (tNY), Positive Nodal Yield (pNY), Nodal yield per level of neck dissected. One-way analysis of variance was used to determine statistical significance amongst operating surgeons. The tNY and pNY were analysed with factorial analysis of variance to determine differences among types of ND and the effects of radiotherapy or chemotherapy. Setting: The Thomas Tatum Head and Neck Unit at St Georges Hospital, Tooting, London.
Results: A significant difference in total nodal yield was found among dissections (p <0.001). Selective neck dissection levels I-III mNY (Mean Lymph Node Yield) was 22.6, I -VI 30 and II-V 19.1. As one would expect the mNY (Mean Lymph Node Yield) from comprehensive ND I-V was 34.1. Previous radiotherapy significantly decreased mean tNY (Total Lymph Node Yield) whereas the presence or absence of preoperative radiotherapy had no significant effect on the positive nodal yield (p =0.6255). The total nodal yield for levels I, III and V showed a higher variability between surgeons. The total nodal yield for selective neck dissection amongst all surgeons was more consistent (Range 19 to 26 nodes).
Discussion: The mean recovery rate of 34 nodes for comprehensive neck dissection (I-V) is near the upper limit of what has been reported in the literature. There are significant differences in the recovery of lymph nodes defined by level, and to our knowledge, no specific current guidelines exist in the literature or in the British Association of Head and Neck Oncologists to indicate the number of nodes per level that would be deemed acceptable to adequately stage the neck.
Conclusion: We propose that an average of 5 nodes per level should be deemed necessary to adequately stage the neck. The variability between surgeons is significant in harvesting lymph nodes in levels I, III and V. This may represent differences in surgical techniques or experience. Previous radiotherapy did not result in a significant reduction in the nodal harvest of the neck contrary to belief.
Messiha A, Woods M, Ryba F, Pinzakoria M, Hyde N, Smith G. Retrospective Study of Nodal Yield from the Neck. World J Oral Maxillofac Surg. 2018;1(2):1008.