Skip to main content
SpringerLink
Log in

Metastasierungsweg und Lymphknotenausräumung beim Unterlippenkarzinom

Metastatic pathways and lymph node dissection in lower lip cancer

  • Leitthema
  • Published:
Der MKG-Chirurg Aims and scope

Zusammenfassung

Bei den meisten bösartigen Neubildungen der Unterlippe handelt es sich um Plattenepithelkarzinome. Mit einer lymphogenen Metastasierungshäufigkeit von ca. 8 % lassen sie sich in ihrem Metastasierungsverhalten zwischen den Plattenepithelkarzinomen der Haut (4–5 %) und dem Mundhöhlenkarzinom (20–40 %) einordnen. Vorwiegend betroffen sind die submentalen und submandibulären Lymphknotenstationen (Level I a und I b), in absteigender Häufigkeit dann die Lymphknoten entlang der Hals-Gefäß-Nerven-Scheide (Level II, III und IV). Das Risiko von Lymphknotenmetastasen steigt mit zunehmender Tumordicke und höherem Entdifferenzierungsgrad (histologisches Grading). Aus der Kombination dieser Faktoren können Patienten mit erhöhtem Metastasierungsrisiko identifiziert werden. Weitere Risikofaktoren sind Tumorgröße, Immunsuppression, perineurales Wachstum, Lymphgefäßinvasion und häufige Rezidive. Bei Patienten mit erhöhtem Risiko für nodale Metastasen sollte auch bei im Staging unauffälligem Lymphknotenstatus (cN0) eine elektive Lymphknotenchirurgie in Erwägung gezogen werden. In der Regel ist dabei eine selektive funktionelle suprahyoidale (Level I und II) oder supraomohyoidale (Level I–III) Ausräumung ausreichend. Eine Erweiterung um weitere Level oder zum modifizierten radikalen Vorgehen ist nur bei Vorliegen von Metastasen notwendig. Alternativ kann auch eine Wächterlymphknotenbiopsie erfolgen, wobei hierzu umfangreiche evidenzsichernde Daten noch fehlen. Die Lymphknotenchirurgie kann sowohl zusammen mit der Primärtumorresektion und meist sofortigen Unterlippenrekonstruktion (einzeitiges Vorgehen) als auch später sekundär (zweizeitiges Vorgehen) erfolgen.

Abstract

The most common histologic entity among lower lip neoplasms is squamous cell carcinoma (SCC). Nodal metastasis is found in approximately 8% of patients, a figure which lies between the dissemination prevalence rates of cutaneous (4–5%) and oral SCC (20–40%). The submental and submandibular lymph nodes (level I a and I b) are most often involved, and nodal metastases are found with decreasing frequency in the cervical nodes of levels II, III and IV along the jugular and carotid sheath. The risk for nodal dissemination rises with increasing tumor depth and dedifferentiation (histologic grading), factors which can be combined to identify patients with a higher risk for nodal metastases. Further risk factors are tumor size, immunosuppression, perineural spread, lymph vessel invasion, and frequent tumor recurrence. In patients with a higher risk for nodal metastases elective lymph node surgery/dissection (ELND) should be considered, even if staging shows no evidence for dissemination (cN0). Selective lymph node dissection (SLND) of level I and II (suprahyoidal SLND) or level I–III (supraomohyoidal SLND) are adequate in cN0 cases. Extension to further levels or modified radical neck dissection is only necessary when metastases are present. Alternatively, sentinel lymph node biopsy (SLNB) can be performed, although adequate evidence-based data on SLNB are currently unavailable. Lymph node surgery in lip cancer can be performed together with resection of the primary tumor and lip reconstruction, or later in a secondary procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Altinyollar H, Bulut H, Berberoglu U (2002) Is suprahyoid dissection a diagnostic operation in lower lip carcinoma? J Exp Clin Cancer Res 21:29–30

    CAS  PubMed  Google Scholar 

  2. Batista AC, Costa NL, Oton-Leite AF et al (2010) Distinctive clinical and microscopic features of squamous cell carcinoma of oral cavity and lip. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 109:e74–79. https://doi.org/10.1016/j.tripleo.2009.10.034

    Article  PubMed  Google Scholar 

  3. Breuninger H (1987) Various aspects of the surgical therapy of cancer of the lower lip. Z Hautkr 62:937–938, 943–946

    CAS  PubMed  Google Scholar 

  4. Breuninger H, Brantsch K, Eigentler T, Häfner H‑M (2012) Comparison and evaluation of the current staging of cutaneous carcinomas. J Dtsch Dermatol Ges 10:579–586. https://doi.org/10.1111/j.1610-0387.2012.07896.x

    PubMed  Google Scholar 

  5. Breuninger H, Schaumburg-Lever G, Holzschuh J, Horny HP (1997) Desmoplastic squamous cell carcinoma of skin and vermilion surface: a highly malignant subtype of skin cancer. Cancer 79:915–919

    Article  CAS  PubMed  Google Scholar 

  6. Bucur A, Stefanescu L (2004) Management of patients with squamous cell carcinoma of the lower lip and N0-neck. J Craniomaxillofac Surg 32:16–18

    Article  PubMed  Google Scholar 

  7. Byers RM, Clayman GL, McGill D et al (1999) Selective neck dissections for squamous carcinoma of the upper aerodigestive tract: patterns of regional failure. Head Neck 21:499–505

    Article  CAS  PubMed  Google Scholar 

  8. Chone CT, Magalhes RS, Etchehebere E et al (2008) Predictive value of sentinel node biopsy in head and neck cancer. Acta Otolaryngol 128:920–924. https://doi.org/10.1080/00016480701760114

    Article  PubMed  Google Scholar 

  9. Czerninski R, Zini A, Sgan-Cohen HD (2010) Lip cancer: incidence, trends, histology and survival: 1970–2006. Br J Dermatol 162:1103–1109. https://doi.org/10.1111/j.1365-2133.2010.09698.x

    Article  CAS  PubMed  Google Scholar 

  10. De Angelis R, Sant M, Coleman MP et al (2014) Cancer survival in Europe 1999–2007 by country and age: results of EUROCARE-5-a population-based study. Lancet Oncol 15:23–34. https://doi.org/10.1016/S1470-2045(13)70546-1

    Article  PubMed  Google Scholar 

  11. Frerich B, Förster M, Schiefke F et al (2007) Sentinel lymph node biopsy in squamous cell carcinomas of the lips and the oral cavity – a single center experience. J Surg Oncol 95:97–105. https://doi.org/10.1002/jso.20664

    Article  PubMed  Google Scholar 

  12. Gooris PJJ, Vermey A, de Visscher JGAM et al (2002) Supraomohyoid neck dissection in the management of cervical lymph node metastases of squamous cell carcinoma of the lower lip. Head Neck 24:678–683. https://doi.org/10.1002/hed.10079

    Article  PubMed  Google Scholar 

  13. Khalil HH, Elaffandi AH, Afifi A et al (2008) Sentinel lymph node biopsy (SLNB) in management of N0 stage T1-T2 lip cancer as a „same day“ procedure. Oral Oncol 44:608–612. https://doi.org/10.1016/j.oraloncology.2007.07.002

    Article  CAS  PubMed  Google Scholar 

  14. Kowalski LP, Magrin J, Waksman G et al (1993) Supraomohyoid neck dissection in the treatment of head and neck tumors. Survival results in 212 cases. Arch Otolaryngol Head Neck Surg 119:958–963

    Article  CAS  PubMed  Google Scholar 

  15. Kreppel M, Krakowezki A, Kreppel B et al (2013) Podoplanin expression in cutaneous head and neck squamous cell carcinoma – prognostic value and clinicopathologic implications. J Surg Oncol 107:376–383. https://doi.org/10.1002/jso.23238

    Article  CAS  PubMed  Google Scholar 

  16. Kuscu O, Bajin MD, Süslü N, Hoşal AŞ (2016) The role of suprahyoid neck dissection in the treatment of squamous cell carcinoma of the lower lip: 20 years’ experience at a Tertiary Center. J Craniomaxillofac Surg 44:1404–1407. https://doi.org/10.1016/j.jcms.2016.06.004

    Article  PubMed  Google Scholar 

  17. Luna-Ortiz K, Güemes-Meza A, Villavicencio-Valencia V, Mosqueda-Taylor A (2004) Lip cancer experience in Mexico. An 11-year retrospective study. Oral Oncol 40:992–999. https://doi.org/10.1016/j.oraloncology.2004.04.013

    Article  PubMed  Google Scholar 

  18. McGregor GI, Davis NL, Hay JH (1992) Impact of cervical lymph node metastases from squamous cell cancer of the lip. Am J Surg 163:469–471

    Article  CAS  PubMed  Google Scholar 

  19. Medina JE, Byers RM (1989) Supraomohyoid neck dissection: rationale, indications, and surgical technique. Head Neck 11:111–122

    Article  CAS  PubMed  Google Scholar 

  20. Robbins KT, Medina JE, Wolfe GT et al (1991) Standardizing neck dissection terminology. Official report of the Academy’s Committee for Head and Neck Surgery and Oncology. Arch Otolaryngol Head Neck Surg 117:601–605

    Article  CAS  PubMed  Google Scholar 

  21. Salgarelli AC, Sartorelli F, Cangiano A et al (2009) Surgical treatment of lip cancer: our experience with 106 cases. J Oral Maxillofac Surg 67:840–845. https://doi.org/10.1016/j.joms.2008.09.020

    Article  PubMed  Google Scholar 

  22. Samarasinghe V, Madan V, Lear JT (2011) Management of high-risk squamous cell carcinoma of the skin. Expert Rev Anticancer Ther 11:763–769. https://doi.org/10.1586/era.11.36

    Article  PubMed  Google Scholar 

  23. Shah JP, Kraus DH, Dubner S, Sarkar S (1991) Patterns of regional lymph node metastases from cutaneous melanomas of the head and neck. Am J Surg 162:320–323

    Article  CAS  PubMed  Google Scholar 

  24. da Silveira EJD, da Miguel MC, Lima KC et al (2010) Analysis of local immunity in squamous cell carcinoma of the tongue and lower lip. Exp Mol Pathol 88:171–175. https://doi.org/10.1016/j.yexmp.2009.11.009

    Article  PubMed  Google Scholar 

  25. Stein AL, Tahan SR (1994) Histologic correlates of metastasis in primary invasive squamous cell carcinoma of the lip. J Cutan Pathol 21:16–21

    Article  CAS  PubMed  Google Scholar 

  26. Vartanian JG, Carvalho AL, de Araújo Filho MJ et al (2004) Predictive factors and distribution of lymph node metastasis in lip cancer patients and their implications on the treatment of the neck. Oral Oncol 40:223–227

    Article  PubMed  Google Scholar 

  27. de Visscher JG, Schaapveld M, Grond AJ, van der Waal I (1999) Relationship of tumor thickness in punch biopsy and subsequent surgical specimens in stage I squamous cell carcinoma of the lower lip. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 88:141–144

    Article  PubMed  Google Scholar 

  28. Vukadinovic M, Jezdic Z, Petrovic M et al (2007) Surgical management of squamous cell carcinoma of the lip: analysis of a 10-year experience in 223 patients. J Oral Maxillofac Surg 65:675–679. https://doi.org/10.1016/j.joms.2006.03.054

    Article  PubMed  Google Scholar 

  29. Wermker K, Belok F, Schipmann S et al (2015) Prediction model for lymph node metastasis and recommendations for elective neck dissection in lip cancer. J Craniomaxillofac Surg 43:545–552. https://doi.org/10.1016/j.jcms.2015.02.002

    Article  PubMed  Google Scholar 

  30. Zitsch RP 3rd, Lee BW, Smith RB (1999) Cervical lymph node metastases and squamous cell carcinoma of the lip. Head Neck 21:447–453

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Mund-Kiefer-Gesichtschirurgie, plastische und ästhetische Operationen, Zentrum für dentale Implantologie, Klinikum Osnabrück, Am Finkenhügel 1, 49076, Osnabrück, Deutschland

    K. Wermker

Authors
  1. K. Wermker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. Wermker.

Ethics declarations

Interessenkonflikt

K. Wermker gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Redaktion

G. Mast, München

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wermker, K. Metastasierungsweg und Lymphknotenausräumung beim Unterlippenkarzinom. MKG-Chirurg 11, 103–110 (2018). https://doi.org/10.1007/s12285-018-0145-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12285-018-0145-6

Schlüsselwörter

Keywords

Search

Navigation