Supraomohyoid neck dissection in the treatment of head and neck tumors. Survival results in 212 cases
L. P. Kowalski, J. Magrin, G. Waksman, G. F. Santo, M. E. Lopes, R. P. de Paula, R. N. Pereira and H. Torloni
Head and Neck Surgery Department, A.C. Camargo Hospital, Antonio Prudente Foundation, Sao Paulo, Brazil.
Elective supraomohyoid neck dissection is considered part of standard
treatment of oral and oropharyngeal cancer in most institutions, but its
role in the treatment of clinically positive neck cancer remains a subject
of controversy. The main object of this study is to report the results of
212 consecutive patients who underwent supraomohyoid neck dissections from
1954 to 1990. Most patients had squamous cell carcinoma of the oral cavity.
Eighty-six patients (40.6%) had histologically positive lymph nodes in the
surgical specimen (sensitivity, 0.55; specificity, 0.53). At the study
closing date there were 58.8% actuarial 10-year overall survival rates.
Forty-five patients (21.2%) had 50 tumor recurrences (32 local, 13
regional, five distant), and in 40 patients (18.8%) a second primary tumor
was diagnosed. A multivariate regression technique based on Cox's
proportional hazards model was used, and age (65 years or younger vs older
than 65 years) represented the variable with the highest predictive
strength with respect to overall survival (relative risk, 2.3). Tumor site,
sex, and histologically proved metastasis were also associated with overall
survival rates. The same variables were also related to the risk of
recurrence. In conclusion, the death rate is mainly related to the control
of the primary site tumor and the occurrence of a second primary tumor
rather than to neck recurrences. It confirms that supraomohyoid neck
dissection is an adequate elective procedure and possibly sufficient in the
treatment of a selected group of patients with lip cancer with positive
nodes at level 1.
