Post-operative progress of arm abduction function and rate of lymph node metastasis around the region of the accessory nerve: a multicentre prospective observational study. (25th January 2023)

• Record Type: Journal Article
• Authors: Tomioka, Toshifumi; Beppu, Takeshi; Onitsuka, Tetsuro; Fujimoto, Yasushi; Kawabata, Kazuyoshi; Matsuura, Kazuto; Fujii, Takashi; Hayashi, Ryuichi; Asakage, Takahiro
• Is Part Of: Japanese journal of clinical oncology. Volume 53:Number 5(2023)
• Page Start: 401
• Page End: 409
• Publication Date: 2023-01-25
• Subjects: arm abduction -- Level V metastasis -- Level IIB metastasis -- accessory nerve -- neck dissection; Oncology -- Periodicals; Cancer -- Periodicals; 616.994005
• DOI: 10.1093/jjco/hyad006
• Languages: English
• ISSNs: 0368-2811

Abstract

Abstract: Objective: Although neck dissection is an essential technique in the surgical treatment of head and neck carcinoma, arm abduction disorders occurring after neck dissection reduce the patient's quality of life. Methods: We prospectively evaluated the rate of lymph node metastasis in Levels IIB and V in head and neck cancer patients who underwent neck dissection at eight centres in Japan. In addition, post-operative arm abduction disability was classified according to functional assessment values at 1 month post-operatively, and the rate of maintained function at 6 and 12 months was evaluated. Results: Lymph node metastasis occurred in Level IIB in 12 of 242 cases (4.9%) and in Level V in 5 cases (2.1%) during the 12-month post-operative course. In patients with preservation of the ipsilateral accessory nerve, arm abduction function was maintained in 142 of 209 patients (67.9%) at 12 months after surgery. Post-operative radiotherapy and Level V dissection had no statistically significant effect on the recovery of arm abduction function. Level V dissection caused a temporary loss of abduction function post-operatively. A higher arm abduction test score at 1 month post-operatively was associated with a higher rate of subsequent ability to maintain arm abduction function. Conclusions: In patients classified as cN0, metastatic rate at Levels IIB and V was low. In this cohort, omitting Level V dissection may be an option in strategies aimed at maintaining arm abduction function. Abstract : In patients classified as cN0, the metastatic rate of Levels IIB and V was low. Omitting Level V dissection may be an optional in strategy aimed at maintaining arm abduction function.