1. REGIONAL METASTATIC DISEASE OF THE NECK NECK DISSECTION
Éva Remenár MD, PhD
Multidisciplinary Head and Neck Cancer Center
National Institute of Oncology, Budapest

2. Head and neck cancer
Common >90% of all HN cancers: squamous cell cancer of the upper aerodigestive tract mucosa
Oral cavity (C00-C06)
Oropharynx (C01, C05, C09, C10)
Hypopharynx (C12, C13)
Larynx (C32)
Rare head and neck cancer
Nasopharynx (C11)
Nasal cavity and sinuses (C30, C31)
Salivary glands (C07, C08)
Cancers of other organs of origin, localized on the head and neck
Skin (C43, C44)
Soft tissue and bone tumors (C49, C41)
Thyroid gland (C73)

3. HEAD AND NECK CANCER INCIDENCE AND MORTALITY IN HUNGARY (National Cancer Registry and KSH Demographic Yearbook 2010)
Incidence
Frequency
Mortality
Oral cavity and pharynx, males
(ICD: C00-C14)
2454/2740
(89,6%) 4.
1339 3.
Larynx, males
(ICD: C32)
999
10.
482
Oral cavity and pharynx, females
(C00-C14)
660/946
(69,7%)
12.
246
14.
Larynx, females
211
21. 62
24.

4. EARLY STAGE ORAL CARITY CANCERS4

5. ADVANCED STAGE ORAL CAVITY CANCER5

6. ADVANCED STAGE CANCER OF THE SUBLINGUAL AREA6

7. ADVANCED STAGE CANCER OF THE LARYNX

8. ADVANCED STAGE CANCER OF THE LEFT PIRIFORM SINUS

9. ADVANCED STAGE CANCER OF THE PAROTID GLAND

10. NECK (REGIONAL) METASTASIS
The presence of regional neck metastasis is the most important bad prognostic factor in head and neck squamous cell cancer
At the time of the diangosis of head and neck cancer >60% of the patients have regional disease on the neck
At least 50% of the patients loco-regional reccurrence within 3 years
Consequently the effective treatment of the neck metastases is very important for the patient

11. REGIONAL METASTASIS AND THE PRIMARY SITE OF CANCER

12. TNM STAGING

13. TNM STAGING

14. TNM TAGING

15. DEEPLY (> 6 mm) INFILTRATING CANCER

16. LYMPHATIC LEVELS AND SUBLEVELS OF THE NECK
Level I
sublevel IA: submentalis
sublevel IB: submandibularis
Level II: upper parajugular
sublevel IIA: jugulo-digastric
sublevel IIB: submuscular (m. scm) recess
Level III: medium parajugularis
Level IV: lower parajugularis
Level V: posterior triangle
sublevel VA: accessory
sublevel VB: transverse cervical and supraclavicular
Level VI: medial compartment
Level VII: upper mediastinal
Robbins RT et al: Consensus Statement on the classification and terminology of neck dissections.
Arch Otolaryngol Head Neck Surg 2008; 134: 16

17. CLASSIFICATION OF NECK DISSECTIONS
Radical neck dissection:
I-V levels and m. scm, v. jugularis interna, n. accessorius eltávolítása
Modified radical neck dissection:
I-V levels but preservation of at least one of the followings: int. Jugular vein, accessory nerve, m. scm
Selective neck dissection:
preservation of at least one level of the neck
Extended neck dissection:
excision of orgas that are usually not part of a radical neck dissection
Robbins KT et al: Neck dissection classification update. Arch Otolaryngol Head Neck Surg 2002; 128:
Robbins RT et al: Consensus Statement on the classification and terminology of neck dissections.
Arch Otolaryngol Head Neck Surg 2008; 134:

18. RADICAL NECK DISSECTION18

19. MODIFIED RADICAL NECK DISSECTION
m. sternocleidomastoideus resected,
Preserved structures:
V. jugularis interna (IJV)
N. accessorius (SAN)
SAN IV 19

20. SELECTIVE NECK DISSECTION
m. sternocleidomastoideus resected,
Preserved structures:
V. jugularis interna (IJV)
N. accessorius (SAN)
SAN
IJV

21. SECTIVE NECK DISSECTION
Level II-III (SND)
Preserved structures:
m. sternocleidomastoideus (SCM)
v. jugularis interna (IJV)
N. accessorius (SAN)
SAN
IJV
SCM

22. THANK YOU FOR
THE ATTENTION!