Endoscopic sentinel lymphadenectomy as a new diagnostic approach in the N0 neck

  • Jochen A. Werner
  • N. R. Sapundzhiev
  • A. Teymoortash
  • A. A. Dünne
  • T. Behr
  • B. J. Folz
Head and Neck Oncology

Abstract

Sentinel lymphadenectomy was developed to reduce the extent of surgical interventions in cancer patients. The sentinel node (SN) concept was first established for melanoma and breast cancer; within some years, it also became increasingly popular for head and neck cancer. As soon as the required sensitivity of the method proves to be feasible in the daily clinical routine, the discussion about the best surgical approach to single or multiple SN(s) will arise. Different objectives may here compete with each other. The incision should render the best exposure of the operation site and should be expandable in case further lymph node regions have to be dissected. Finally, a good functional as well as a good cosmetic result is desirable. Endoscopic lymph node excisions were performed in patients suffering from squamous cell carcinoma of the upper aerodigestive tract located in different sites (1× uvula, 2× epiglottis, 1× glottis). In preoperatively performed ultrasonic imaging (B-mode-ultrasonography), N0 necks were assessed. In contrast to previously reported endoscopic techniques in humans, the presented method requires no insufflation of carbon dioxide or external retraction of the skin. Following laser surgical resection of the primary tumor, the SN and further lymph node(s) with accumulation of tracer substance were identified and resected endoscopically via an incision that was afterwards extended to a normal neck dissection incision. Reports of histopathologic examination of the sentinel node(s) were compared to the respective neck dissection specimens. The presented method may help to reduce the degree of invasiveness frequently attributed to sentinel lymphadenectomy once the method has been established for head and neck cancer.

Keywords

N0-neck Sentinel node Minimally invasive surgery Endoscopy 

References

  1. 1.
    Beger HG, Schwarz A, Bergmann U (2003) Progress in gastrointestinal tract surgery: the impact of gastrointestinal endoscopy. Surg Endosc 17:342–350CrossRefPubMedGoogle Scholar
  2. 2.
    Liu Y, Zhang X (2002) Analysis of complications about gynecologic endoscopic procedures in 14 hospitals of Shanghai during 1992–2001. Zhonghua Fu Chan Ke Za Zhi 37:646–649PubMedGoogle Scholar
  3. 3.
    Einarsson JI, Young A, Tsien L, Sangi-Haghpeykar H (2002) Perceived proficiency in endoscopic techniques among senior obstetrics and gynecology residents. J Am Assoc Gynecol Laparosc 9:158–164PubMedGoogle Scholar
  4. 4.
    Gagner M (1996) Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 83:875PubMedGoogle Scholar
  5. 5.
    Dulguerov P, Leuchter I, Szalay-Quinodoz I, Allal AS, Marchal F, Lehmann W, Fasel JH (2001) Endoscopic neck dissection in human cadavers. Laryngoscope 111:2135–2139CrossRefPubMedGoogle Scholar
  6. 6.
    Carreno OJ, Wilson WR, Nootheti PK (1999) Exploring endoscopic neck surgery in a porcine model. Laryngoscope 109:236–240CrossRefPubMedGoogle Scholar
  7. 7.
    Rubino F, Deutsch H, Pamoukian V, Zhu JF, King WA, Gagner M (2000) Minimally invasive spine surgery: an animal model for endoscopic approach to the anterior cervical and upper thoracic spine. J Laparoendosc Adv Surg Tech A 10:309–313PubMedGoogle Scholar
  8. 8.
    Bellantone R, Lombardi CP, Raffaelli M, Boscherini M, De Crea C, Traini E (2002) Video-assisted thyroidectomy. J Am Coll Surg 194:610–614CrossRefPubMedGoogle Scholar
  9. 9.
    Spinelli C, Lima M, Miccoli P (2002) Video-assistive minimally invasive surgical procedures in the treatment of thyroid in children and adolescents. Pediatr Med Chir 24:217–219PubMedGoogle Scholar
  10. 10.
    Ikeda Y, Takami H, Niimi M, Kan S, Sasaki Y, Takayama J (2001) Endoscopic thyroidectomy by the axillary approach. Surg Endosc. 15:1362–1364Google Scholar
  11. 11.
    Norman J, Albrink MH (1997) Minimally invasive videoscopic parathyroidectomy: a feasibility study in dogs and humans. J Laparoendosc Adv Surg Tech A 7:301–306PubMedGoogle Scholar
  12. 12.
    Yeung GH (1998) Endoscopic surgery of the neck: a new frontier. Surg Laparosc Endosc 8:227–232CrossRefPubMedGoogle Scholar
  13. 13.
    Guerrissi JO (2002) Innovation and surgical techniques: endoscopic resection of cervical branchiogenic cysts. J Craniofac Surg 13:478–482CrossRefPubMedGoogle Scholar
  14. 14.
    Rubino F, Nahouraii R, Deutsch H, King W, Inabnet WB, Gagner M (2002) Endoscopic approach for carotid artery surgery. Surg Endosc 16:789–794CrossRefPubMedGoogle Scholar
  15. 15.
    Cougard P, Cheynel N, Peschaud F, Bilosi M, Goudet P (2002) Le “pneumocou” dans la vidéocervicoscopie: technique opératoire et limites anatomiques. Ann Chir 127:310–314CrossRefPubMedGoogle Scholar
  16. 16.
    Werner JA, Dünne AA, Ramaswamy A, Folz BJ, Brandt D, Külkens C, Moll R, Lippert BM (2002) Number and location of radiolabeled, intraoperatively identified sentinel nodes in 48 head and neck cancer patients with clinically staged N0 and N1 neck. Eur Arch Otorhinolaryngol 259:91–96CrossRefPubMedGoogle Scholar
  17. 17.
    Werner JA, Dünne AA, Ramaswamy A, Folz BJ, Lippert BM, Moll R, Behr T (2002) Sentinel node detection in N0 cancer of the pharynx and larynx. Br J Cancer 87:711–715CrossRefPubMedGoogle Scholar
  18. 18.
    Werner JA, Dünne AA, Ramaswamy A, Brandt D, Külkens C, Folz BJ, Moll R, Lippert BM (2002) Das Sentinel node Konzept bei Plattenepithelkarzinomen der oberen Luft- und Speisewege – eine kritische Analyse an 100 Patienten. Laryngorhinootol 81:31–39CrossRefGoogle Scholar
  19. 19.
    Robbins KT, Clayman G, Levine PA, Medina J, Sessions R, Shaha A, Som P, Wolf GT; American Head and Neck Society. American Academy of Otolaryngology—Head and Neck Surgery (2002) Neck dissection classification update: revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology and Head and Neck Surgery. Arch Otolaryngol Head Neck Surg 128:751–758PubMedGoogle Scholar
  20. 20.
    Monfared A, Saenz Y, Terris DJ (2002) Endoscopic resection of the submandibular gland in a porcine model. Laryngoscope 112:1089–1093CrossRefPubMedGoogle Scholar
  21. 21.
    Rubino F, Pamoukian VN, Zhu JF, Deutsch H, Inabnet WB, Gagner M (2000) Endoscopic endocrine neck surgery with carbon dioxide insufflation: the effect on intracranial pressure in a large animal model. Surgery 128:1035–1042CrossRefPubMedGoogle Scholar
  22. 22.
    Kitano H, Fujimura M, Kinoshita T, Kataoka H, Hirano M, Kitajima K (2002) Endoscopic thyroid resection using cutaneous elevation in lieu of insufflation. Surg Endosc 16:88–91CrossRefPubMedGoogle Scholar
  23. 23.
    Cougard P, Cheynel N, Peschaud F, Bilosi M, Goudet P (2002) Le “pneumocou” dans la vidéocervicoscopie: technique opératoire et limites anatomiques. Ann Chir 127:310–331CrossRefPubMedGoogle Scholar
  24. 24.
    Naitoh T, Gagner M, Garcia-Ruiz A, Heniford BT (1998) Endoscopic endocrine surgery in the neck. An initial report of endoscopic subtotal parathyroidectomy. Surg Endosc 12:202–205CrossRefPubMedGoogle Scholar
  25. 25.
    Gottlieb A, Sprung J, Zheng XM, Gagner M (1997) Massive subcutaneous emphysema and severe hypercarbia in a patient during endoscopic transcervical parathyroidectomy using carbon dioxide insufflation. Anesth Analg 84:1154–1156PubMedGoogle Scholar
  26. 26.
    Dralle H, Lorenz K, Nguyen-Thanh P (1999) Minimally invasive video-assisted para-thyroidectomy—selective approach to localized single gland adenoma. Langenbecks Arch Surg 384:556–562CrossRefPubMedGoogle Scholar
  27. 27.
    Guerrissi JO (2002) Innovation and surgical techniques: endoscopic resection of cervical branchiogenic cysts. J Craniofac Surg 13:478–482CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Jochen A. Werner
    • 1
  • N. R. Sapundzhiev
    • 1
  • A. Teymoortash
    • 1
  • A. A. Dünne
    • 1
  • T. Behr
    • 2
  • B. J. Folz
    • 1
  1. 1.Department of Otolaryngology, Head and Neck SurgeryPhilipps University of MarburgMarburgGermany
  2. 2.Department of Nuclear MedicinePhilipps University of MarburgMarburgGermany

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