Surgical Oncologist and Surgeon AURA Veterinary Guildford, England, United Kingdom
The incidence of metastasis to regional lymph nodes in cases of oral neoplasia has been reported in over 35% of patients. Metastasis may have a negative infleunce on patient outcome, so documenting the status of the lymph nodes by histological review is now well established.
A surgical approach has been described for excision of the ipsilateral mandibular, medial retropharyngeal, and parotid lymph nodes through a single incision. Bilateral removal of the mandibular and medial retropharyngeal has also been reported, as contralateral metastasis may occur in more than 13% of patients. Transient lymphedema is seen in many patients after lymph node resection; this can be more impactful after bilateral extirpation with risks of abscessation and respiratory compromise.
The concept of the sentinel node is playing an increasing role in oncosurgery. The sentinel node is the first lymph node that receives lymphatic drainage from a tumor, and its status can indicate whether cancer has spread beyond the primary site. The focus on the sentinel node is important, as this can help in minimizing surgery-related morbidity. If only the sentinel node is removed, this can reduce the extent of surgery required, limiting the more widespread disruption of lymphatic channels that can cause lymphoedema.
The sentinel node will often differ from the node that would be presumed to drain the tumour site based on anatomical location, so specific imaging techniques to identify the sentinel node have been developed. Sentinel lymph node mapping involves the injection of a dye or microbubbles around the tumor. This allows for the identification of the sentinel lymph node, which is then removed for evaluation. Imaging can be completed prior to surgery with CT or ultrasound, or can be performed intraoperatively.
This lecture will discuss these techniques and their incorporation into the surgical management of the oral tumor patient.
