Kirurško liječenje metastaza karcinoma glave i vrata

master's thesis

• Title (english): Surgical treatment of metastasis in head and neck carcinoma
• Author: Iva Crnjak
• Mentor: Mario Bilić (mentor)
• Committee member: Srećko Branica (predsjednik povjerenstva)
• Committee member: Krsto Dawidowsky (član povjerenstva)
• Committee member: Mario Bilić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Othorhinolaryngology and Head and Neck Surgery); Zagreb
• Defense date and country: 2018-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Otorhinolaryngology
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Većina karcinoma glave i vrata su karcinomi pločastih stanica koji se razvijaju u sluznici gornjeg aerodigestivnog trakta. Najznačajniji etiološki čimbenici koji pogoduju njihovom nastanku su alkohol i duhan. Karcinomi glave i vrata metastaziraju u regionalne limfne čvorove vrata. Poznato je kako je zahvaćenost limfnih čvorova uz veličinu, lokalizaciju i prisutnost ekstrakapsularnog širenja najvažniji prognostički faktor. Ukoliko su zahvaćeni regionalni limfni čvorovi, stopa preživljenja bolesnika značajno se smanjuje. Liječenje metastaza regionalnih limfnih čvorova temelji se na poznavanju uobičajenog obrasca širenja karcinoma ovisno o primarnom mjestu nastanka. Ovaj rad donosi pregled disekcija vrata, kirurških zahvata u liječenju regionalnih metastaza karcinoma glave i vrata. Dugo vremena je radikalna disekcija vrata, kojom se odstranjaju ipsilateralni limfni čvorovi svih regija vrata, akcesorni živac, sternokleidomastoidni mišić i unutarnja jugularna vena, bila zlatni standard u kirurškom liječenju metastaza. Tijekom posljednjih nekoliko desetljeća razvili su se brojni, manje radikalni zahvati koji prezerviraju određene limfatičke ili nelimfatičke strukture ovisno o sijelu metastaza. Danas se radikalna disekcija vrata izvodi u manjem broju slučajeva, dok je u većini zamijenjena modificiranom radikalnom ili selektivnom disekcijom vrata zbog manjeg broja morbiditeta i jednako dobrog onkološkog rezultata.

Abstract (english)

Most head and neck cancers are squamous cell carcinomas that arise in the epithelial layer of the mucous membrane which lines the upper aerodigestive tract. The most significant risk factors associated with the pathogenesis of these cancers are tobacco and alcohol consumption. Head and neck cancers have a tendency to metastasise to cervical lymph nodes. It is known that the status of lymph nodes along with size, localisation and extranodal spread is the most important prognostic factor. The presence of lymph node metastases significantly decreases patient survival rates. The treatment of metastastatic lymph nodes is based on the patterns of metastases, which are common depending on the primary site of cancer. This paper provides a review of neck dissections, surgical procedures in the treatment of metastasis in head and neck carcinoma. Radical neck dissection, which refers to the removal of all ipsilateral cervical lymph node levels including the sternocleidomastoid muscle, spinal accessory nerve and internal jugular vein, has been the gold standard of neck nodal treatment for a long time. Over the last few decades, several less radical procedures that retain certain lymphatic or non-lymphatic structures have been developed. Today, radical dissection of the neck is performed in a small number of cases, while most have been replaced by modified radical or selective neck dissection due to a reduced morbidity and equal oncological results.

• Keywords: karcinomi glave i vrata; regionalne metastaze; disekcija vrata
• Keywords (english): head and neck carcinoma; regional metastases; neck dissection
• Language: croatian
• URN:NBN: urn:nbn:hr:105:296225
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2018-12-20 09:16:22