PDF(Pubmed)
Abstract：
OBJECTIVE: Cutaneous Squamous Cell Carcinoma (cSCC), a tumor with a significantly increasing incidence, is mostly diagnosed in the head region, where tumors have a worse prognosis and a higher risk of metastases. The presence of metastases reduces specific five-year survival from 99% to 50%. As the risk of occult metastases does not exceed 10%, elective dissection of the tributary parotid and neck lymph nodes is not recommended.
METHODS: We retrospectively analyzed a group of 12 patients with cSCC of the head after elective dissections of regional (parotid and cervical) nodes by means of superficial parotidectomy and selective neck dissection.
RESULTS: We diagnosed occult metastases neither in the cervical nor parotid nodes in any patient. None were diagnosed as a regional recurrence during the follow-up period.
CONCLUSIONS: Our negative opinion on elective parotidectomy and neck dissection in cSCC of the head is in agreement with the majority of published studies. These elective procedures are not indicated even for tumors showing the presence of known (clinical and histological) risk factors for lymphogenic spread, as their positive predictive value is too low. Elective parotidectomy is individually considered as safe deep surgical margin. If elective parotidectomy is planned it should include only the superficial lobe. Completion parotidectomy and elective neck dissection are done in rare cases of histologically confirmed parotid metastasis in the parotid specimen. Preoperatively diagnosed parotid metastases without neck involvement are sent for total parotidectomy and elective selective neck dissection. Cases of clinically evident neck metastasis with no parotid involvement, are referred for comprehensive neck dissection and elective superficial parotidectomy. The treatment of concurrent parotid and cervical metastases includes total conservative parotidectomy and comprehensive neck dissection.
METHODS: How common is the problem? Step 4 (Case-series) Is this diagnostic or monitoring test accurate? (Diagnosis) Step 4 (poor or non-independent reference standard) What will happen if we do not add a therapy? (Prognosis) Step 4 (Case-series) Does this intervention help? (Treatment Benefits) Step 4 (Case-series) What are the COMMON harms? (Treatment Harms) Step 4 (Case-series) What are the RARE harms? (Treatment Harms) Step 4 (Case-series) Is this (early detection) test worthwhile? (Screening) Step 4 (Case-series).
METHODS: We retrospectively analyzed a group of 12 patients with cSCC of the head after elective dissections of regional (parotid and cervical) nodes by means of superficial parotidectomy and selective neck dissection.
RESULTS: We diagnosed occult metastases neither in the cervical nor parotid nodes in any patient. None were diagnosed as a regional recurrence during the follow-up period.
CONCLUSIONS: Our negative opinion on elective parotidectomy and neck dissection in cSCC of the head is in agreement with the majority of published studies. These elective procedures are not indicated even for tumors showing the presence of known (clinical and histological) risk factors for lymphogenic spread, as their positive predictive value is too low. Elective parotidectomy is individually considered as safe deep surgical margin. If elective parotidectomy is planned it should include only the superficial lobe. Completion parotidectomy and elective neck dissection are done in rare cases of histologically confirmed parotid metastasis in the parotid specimen. Preoperatively diagnosed parotid metastases without neck involvement are sent for total parotidectomy and elective selective neck dissection. Cases of clinically evident neck metastasis with no parotid involvement, are referred for comprehensive neck dissection and elective superficial parotidectomy. The treatment of concurrent parotid and cervical metastases includes total conservative parotidectomy and comprehensive neck dissection.
METHODS: How common is the problem? Step 4 (Case-series) Is this diagnostic or monitoring test accurate? (Diagnosis) Step 4 (poor or non-independent reference standard) What will happen if we do not add a therapy? (Prognosis) Step 4 (Case-series) Does this intervention help? (Treatment Benefits) Step 4 (Case-series) What are the COMMON harms? (Treatment Harms) Step 4 (Case-series) What are the RARE harms? (Treatment Harms) Step 4 (Case-series) Is this (early detection) test worthwhile? (Screening) Step 4 (Case-series).
摘要：
目标：皮肤鳞状细胞癌（cSCC），发病率显著增加的肿瘤，主要诊断在头部，肿瘤预后较差，转移风险较高。转移的存在将特定的五年生存率从99%降低到50%。由于隐匿性转移的风险不超过10％，不建议选择性切除分支腮腺和颈部淋巴结.
方法：我们回顾性分析了一组12例cSCC患者，这些患者通过浅表腮腺切除术和选择性颈淋巴结清扫术对局部（腮腺和颈部）淋巴结进行选择性解剖后，头部cSCC。
结果：我们在任何患者中诊断出宫颈和腮腺淋巴结均未发生隐匿性转移。在随访期间，没有人被诊断为区域性复发。
结论：我们对头部cSCC选择性腮腺切除术和颈部清扫术的否定意见与大多数已发表的研究一致。即使对于存在已知（临床和组织学）淋巴源性扩散危险因素的肿瘤，这些选择性手术也不适用。因为它们的阳性预测值太低。选择性腮腺切除术被认为是安全的深手术切缘。如果计划进行选择性腮腺切除术，则应仅包括浅叶。在腮腺标本中经组织学证实的腮腺转移的罕见病例中，进行了腮腺切除术和选择性颈清扫术。术前诊断为无颈部受累的腮腺转移，进行全腮腺切除术和选择性颈部清扫术。临床上明显的颈部转移，无腮腺受累，适用于综合颈清扫术和选择性浅表腮腺切除术。合并腮腺和宫颈转移的治疗包括保守性全腮腺切除术和综合颈清扫术。
方法：问题有多普遍？第4步（病例系列）此诊断或监测测试是否准确？（诊断）第4步（不良或非独立参考标准）如果我们不添加治疗会发生什么？（预后）第4步（病例系列）这种干预措施有帮助吗？（治疗益处）第4步（病例系列）什么是共同危害？（治疗4例）
方法：我们回顾性分析了一组12例cSCC患者，这些患者通过浅表腮腺切除术和选择性颈淋巴结清扫术对局部（腮腺和颈部）淋巴结进行选择性解剖后，头部cSCC。
结果：我们在任何患者中诊断出宫颈和腮腺淋巴结均未发生隐匿性转移。在随访期间，没有人被诊断为区域性复发。
结论：我们对头部cSCC选择性腮腺切除术和颈部清扫术的否定意见与大多数已发表的研究一致。即使对于存在已知（临床和组织学）淋巴源性扩散危险因素的肿瘤，这些选择性手术也不适用。因为它们的阳性预测值太低。选择性腮腺切除术被认为是安全的深手术切缘。如果计划进行选择性腮腺切除术，则应仅包括浅叶。在腮腺标本中经组织学证实的腮腺转移的罕见病例中，进行了腮腺切除术和选择性颈清扫术。术前诊断为无颈部受累的腮腺转移，进行全腮腺切除术和选择性颈部清扫术。临床上明显的颈部转移，无腮腺受累，适用于综合颈清扫术和选择性浅表腮腺切除术。合并腮腺和宫颈转移的治疗包括保守性全腮腺切除术和综合颈清扫术。
方法：问题有多普遍？第4步（病例系列）此诊断或监测测试是否准确？（诊断）第4步（不良或非独立参考标准）如果我们不添加治疗会发生什么？（预后）第4步（病例系列）这种干预措施有帮助吗？（治疗益处）第4步（病例系列）什么是共同危害？（治疗4例）
