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![]() 11, 12 However, to our knowledge, no prospective data have been examined to determine relations between the number of nodes removed in neck dissection and oncologic outcomes such as locoregional recurrence and survival. In the head and neck surgical oncology literature, retrospective single and multicenter studies have attempted to address surgical quality in neck dissection. 6- 9 This quality metric was adopted for patients with colorectal cancer in the 2009 National Voluntary Consensus Standards for Quality of Cancer Care. For patients with stage II or III colorectal cancer, the removal of 12 or more lymph nodes is associated with increased overall survival. For other solid malignancies such as colorectal cancer, prospective studies have demonstrated the impact of the quality and extent of surgery on survival and, in particular, the number of lymph nodes retrieved during regional nodal dissection. As such, there may be significant variability in the quality of cervical lymphadenectomy. 4ĭespite efforts to standardize and classify techniques, 5 the practice of neck dissection now varies widely across centers and from surgeon to surgeon. In 1984, Byers introduced the more conservative modified radical neck dissection, 3 which preserved the sternocleidomastoid muscle, internal jugular vein, and cranial nerve XI, and eventually advocated selective neck dissection, which removed fewer than all 5 levels of the neck. 2 However, over time, neck dissection evolved. Beginning in 1951, Hates Martin promoted radical neck dissection as an en bloc ipsilateral resection of all lymphatic tissues of the neck as well as the sternocleidomastoid muscle, internal jugular vein, and spinal accessory nerve (cranial nerve XI). After Crile 1 proposed the systematic management of regional lymphatics of the neck in 1906, the procedure became widely practiced and adopted as an integral aspect of managing head and neck cancer. Neck dissection is the cornerstone of modern head and neck surgery. The removal and identification of 18 or more lymph nodes was associated with improved overall survival and lower rates of local-regional failure, and this should be further evaluated as a measure of quality in neck dissections for mucosal squamous cell carcinoma. When the analysis was limited to NRG Oncology RTOG 0234 patients, adding the p16 status to the model did not affect the HR for dissected nodes, and the effect of nodes did not differ with the p16 status. The identification of fewer than 18 nodes was associated with worse overall survival in comparison with 18 or more nodes (hazard ratio, 1.38 95% confidence interval, 1.09-1.74 P = .007). The median numbers of lymph nodes recorded on the left and right sides were 24 and 25, respectively. Ninety-eight percent of the patients were pathologically N+. RESULTSįive hundred seventy-two patients were analyzed at a median follow-up of 8 years. The number of lymph nodes counted from neck dissection in patients treated in 2 NRG Oncology trials (Radiation Therapy Oncology Group 9501 and RTOG 0234) was evaluated for its prognostic impact on overall survival with a multivariate Cox model adjusted for demographic, tumor, and lymph node data and stratified by the postoperative treatment group. The purpose of this study was to investigate the association between lymph node counts from neck dissection, local-regional recurrence, and overall survival. Similar, yet not identical, capillaries exist in the lungs where blood receives oxygen.Prospective quality metrics for neck dissection have not been established for patients with head and neck squamous cell carcinoma. The vessels and lymph create a one-way system that interacts with the circulatory system at capillaries, permeable vessels that allow for the lymph and circulatory systems to interact as lymph enters the bloodstream. Both create antibodies that “remember” the pathogen and are prepared to mount a defense against it should the body ever encounter it again. T cells & B cells: Made in the thymus and bones, respectively, these white blood cells target specific pathogens or infected cells.NK cells: Called “natural killer” cells, these play a large role in defending the body against viruses and tumors.It contains disease-fighting white blood cells, specifically lymphocytes, a type of white blood cell. The vessels transport a fluid called lymph. For example, the nodes in the neck are called cervical nodes (after the cervical part of the vertebral column) and mandibular nodes (after the mandible, or jawbone). The parts of the lymphatic system are named after the area of the body in which they are found.
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