Preservação da veia jugular interna em pacientes portadores de carcinoma epidermóide de cabeça e pescoço submetidos a esvaziamento cervical radical / Preservation of the internal jugular vein in patients with epidermoid carcinoma of the head and neck submitted to radical neck dissection

AUTOR(ES)

Everton Pontes Martins

DATA DE PUBLICAÇÃO

2007

RESUMO

There is great controversy about preservation of the internal jugular vein as a modification of the radical neck dissection, in planning the therapy of regional metastases in patients with epidermoid carcinomas of the upper aerodigestive tract. The aim of this study was to assess the influence of preserving the internal jugular vein on the efficacy of treating regional metastasis in selected cases of epidermoid carcinomas of the head and neck, submitted to radical neck dissection. For this purpose, a retrospective analysis was made of 311 patients with epidermoid carcinomas of the mouth, oropharynx, larynx or hypopharynx, submitted to surgery-based treatment that involved radical neck dissection, with or without preservation of the internal jugular vein in at least one of the sides of the neck, all with cervical metastases proven by anatomic-pathologic considerations. Of the 311 radical neck dissection ipsilateral to the primary tumor, the internal jugular vein was preserved in 109 (35%) cases. Regional recurrence ipsilateral to the primary tumor was detected in 18 patients (5.8%), with 14 (4.5%) initially being submitted to radical neck dissection without preserving the internal jugular vein and 4 (1.3%) being treated with radical neck dissection with preservation of the internal jugular vein. Regional recurrence ipsilateral to the primary tumor was not significantly related to preservation of the internal jugular vein (p=0.313), the T (p= 0.364) or N (p= 0.963) stage, adjuvant radiotherapy (p=0.701), the number of positive lymph nodes in the operative tissue product (p=0,886) and capsular lymph nodal invasion by tumoral metastases (p=0.802). The size of the lymph node compromised by disease, when greater than or equal to 3 cm, was the only variable that showed statistical significance for regional recurrence (p=0.04). The overall survival rate in the study was 57% in 2 years and 35% in 5 years. Taking into consideration either the preservation of the internal jugular vein or not, survival was 46% and 29% in 5 years, respectively (p=0.02). It was concluded that preserving the internal jugular vein, as a modification of radical neck dissection in the treatment of epidermoid carcinomas of the mouth, oropharynx, larynx or hypopharynx was safe, irrespective of the N stage, without interfering in regional control and in the survival rates of this group of patients.

ASSUNTO(S)

neoplasias de cabeça e pescoço carcinoma squamous cell esvaziamento cervical jugular veins carcinoma de células escamosas risk factors head and neck neoplasms veias jugulares neck dissection fatores de risco

Documentos Relacionados

• Preservação da veia jugular interna em pacientes portadores de carcinoma epidermóide de cabeça e pescoço submetidos a esvaziamento cervical radical
• Edema na face e pescoço após esvaziamento cervical com ou sem ressecção da veia jugular interna
• O esvaziamento cervical e a conservação da veia jugular interna, do musculo esternocleidomastoideo e do nervo espinal acessorio no tratamento dos pacientes portadores de carcinoma epidermoide da laringe ou da hipofaringe : analise prospectiva de 115 casos
• Análise molecular das margens cirúrgicas de pacientes com carcinoma epidermóide de cabeça e pescoço.
• Recidivas regionais nos pacientes com carcinoma epidermóide das vias aerodigestivas superiores submetidos à esvaziamento cervical