头颈癌的手术治疗课件

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1、JosephCalifano,M.D.DepartmentofOtolaryngology-HeadandNeckSurgeryJohnsHopkinsUniversityBaltimore,MDUSASurgicalManagementoftheNeckinHeadandNeckCancerGeneralGoalsReviewtheindicationsformanagementofcervicalnodalmetastasisinheadandneckcancerIndicationsforselective,stagingneckdissectio

2、nNewertechniques,includingsentinelnodebiopsyLevelsoftheNeckIIVVIIIIIIVSublevelsoftheNeckIAIVVIIIIIIAVAIBIIBVBNeckDissection:TerminologyAHNSrecommendationsfavordescriptiveterminologytoobtainbetterprecisionNecklevelsStructurespreservedStructuressacrificedSourcesofBiasinLiteratureRe

3、gardingNeckDissectionAlmostalldatafromretrospectiveanalysesNostandardmethodofidentificationoflevelsbypathologistBothcontralateralandipsilateralnecksarereportedLocalizationofprimarysitescanbechallengingNeckDissectionStaging:AvarietyofselectiveneckdissectionsforstagingofHNSCwithN0d

4、iseaseTherapy:UsuallyacomprehensiveneckdissectionforknownpresenceofdiseaseHistoricalApproachGeorgeCrile’sinitialdescriptionofneckdissection:bleedingcontrolledbyclampingofcommoncarotidartery“softeningofthebrain”notedpostoperativelyRadicalneckdissection:removaloflevelsI-VInternalJu

5、gularVeinSternocleidomastoidCNXIRadicalNeckDissectionModifiedNeckDissectionModifiedneckdissection:preservationofoneormoreofthefollowingifnotdirectlyinvadedInternalJugularVeinSternocleidomastoidCNXISubmandibulargland,etc.(Boccaetal.1967)ComparisonofMRNDvs.RNDregionalrecurrenceRadi

6、calNeckDissection13-16%ModifiedNeckDissection6-9%ImprovedshoulderfunctionwithCNXIpreservationNeckDissectionWithPreservationoftheSCM,IJ,andCNXISelectivevs.Comprehensive/(I-V)NeckDissectionRemovalofaportionofnodalgroupsbasedonpreferentialmetastasesfromknownprimarysiteLindberg,Canc

7、er,1972Buckley,HeadandNeck,2001PrimaryRationale:Staging,determinationofnodalinvolvementtoguidefurthertherapy,usuallyradiotherapyorconversiontocomprehensiveneckdissection(I-V)ifintraoperativediseaseSelectivevs.Comprehensive/(I-V)NeckDissectionSecondaryRationale:Therapy,clearanceo

8、fknownorsuspectednodaldiseaseControversy