engleski

Evolution in the Phylosophy of Neck Dissetion

Define the number of dissection and indication dynamics in last two decades and change of attitude reflected on tumor position and make dissection (date 1982-2001, ENT dept. University Hospital "Sestre Milosrdnice", Zagreb). Idea: Since the first Crile surgeon procedures we follow up evolution and proceeding of the neck dissection. In time some new and more selective methods are being introduced. In 90's, to diferentiate it from the 80's, there has been strict acceptance of accomplishment of the neck dissections, according to contemporary protocols of the removal of micrometastasis. Due to that, the new metodology of preoperative staging has been introduced, as well as postoperative follow up, sistematized nomenklature, the number of elective and bilateral dissections. Elective radiotherapies and postsurgical irradiations have also been decreased. The entire philosophy of surgical treatment of head and neck carcinoma has been changed in account of planning and proceeding the dissection. Metod: Patient with squamose cell head and neck carcinoma. Position of primary tumor was located. Data collected: date of procedure, age, sex and surgeon. Data were processed in two decades (1982-1991 and 1992-2001). Results: In 90-ies increased number of bilateral and selective and decreased number of modificated neck dissections was observed and in in 90-ies there was increasing number of dissections which was added to laryngectomies, while in 1999 the number of dissections was larger than laryngectomies what indicates large number of bilateral dissections. Supraglottis tumor requires bilateral dissection. Bilateral dissections were made only 10 % in 80-ies and 90 % in 90-ies. This difference occured while modern treatment of supraglottis tumor requires bilateral dissection treatment and was mainly made in 90-ies. Total number of dissections with their radicality is increasing in 90-ies Conclusions: In 90-ies we have strict acceptance of acknowledgments about tumor methastasis, systematized nomenclature, increased number of elective and bilateral dissections and decreased number of elective and postsurgical irradations.

neck dissection; history of

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