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Original communication| Volume 18, ISSUE 5, P608-619, November 1945

The surgical problem of cancer in lymph nodes

DOI:https://doi.org/10.5555/uri:pii:003960604590081X
The surgical problem of cancer in lymph nodes
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      Abstract

      • 1.
        1. The role of the lymphatic vessels and nodes in cancer dissemination is briefly discussed.
      • 2.
        2. It appears remarkable that prevailing opinions regarding the treatment of occult cancer in lymph nodes should remain so divergent.
      • 3.
        3. In an attempt to shed some light on the question the factors relating to the incidence of node metastases and to node removal are reviewed.
      • 4.
        4. The arguments for and against prophylactic node dissection are examined as they pertain to carcinoma of the lip, since comparable and reliable figures are at present available for this group alone.
      • 5.
        5. When the results of each method of treatment are examined, it is found that the anticipated greater survival among those prophylactically dissected and having involved nodes (as compared to those dissected after the nodes have been permitted to become clinically apparent) is overbalanced by a greater number of operative deaths most of which occurred in patients whose nodes were found on pathologic study to be uninvolved.
      • 6.
        6. Such unnecessary deaths can largely be eliminated by more careful attention to factors predisposing to node metastases reserving dissection for those in whom such factors are prominent.
      • 7.
        7. It is further suggested that patients having carcinoma of the lip and arriving for treatment with nodes already present in the neck be given the benefit of total neck dissection whenever possible since on specimen study they are found to have approximately three times as many involved nodes as those who develop the nodes after the primary tumor has been treated or are found to have involved nodes on prophylactic dissection. It is felt that upper neck dissections have largely contributed to the poorer prognosis of the first mentioned group and should be reserved for patients who are prophylactically dissected or whose nodes develop while under close observation.
      • 8.
        8. The employment of aspiration biopsy will be of great diagnostic aid in making such distinctions.
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      Article info

      Publication history

      Received: June 19, 1945

      Identification

      DOI: https://doi.org/10.5555/uri:pii:003960604590081X

      Copyright

      © 1945 Published by Elsevier Inc.

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