Disekcije vrata u 21. stoljeću

master's thesis

• Title (english): Neck dissection in the 21st century
• Author: Erik Šuvak
• Mentor: Alan Pegan (mentor)
• Committee member: Jakov Ajduk (predsjednik povjerenstva)
• Committee member: Mihael Ries (član povjerenstva)
• Committee member: Alan Pegan (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Othorhinolaryngology and Head and Neck Surgery); Zagreb
• Defense date and country: 2024-09-11, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Otorhinolaryngology

Abstract

Glava i vrat obuhvaćaju neke od najkompleksnijih anatomskih regija u tijelu, s visokom koncentracijom vitalnih struktura u skučenom prostoru. Poznavanje anatomije i limfnog sustava ključno je za razumijevanje širenja raka u području vrata te za uspješno izvođenje terapijskih postupaka. Većina karcinoma glave i vrata barem je potencijalno izlječiva. Primarni karcinom koji
nastaje u većini dijelova glave i vrata obično metastazira u regionalne limfne čvorove. Stanje tih limfnih čvorova najvažniji je neovisni čimbenik prognoze kod karcinoma glave i vrata, pa je pravilno upravljanje limfnim čvorovima ključno za kontrolu bolesti. Naime, u slučaju samo jednog pozitivnog limfnog čvora, petogodišnje preživljenje pada na 50%. Prije revolucionarnog razvoja disekcije vrata, karcinomi glave i vrata smatrali su se neizbježno smrtonosnom dijagnozom. Disekcija vrata postala je standardni kirurški postupak za uklanjanje karcinoma iz regionalnih limfnih čvorova u 19. stoljeću. Cilj je ukloniti limfne čvorove koji su zahvaćeni ili su pod rizikom od metastaza. Od svog početka do danas, disekcija vrata prošla je kroz brojne modifikacije. U početku, to je bio izrazito mutilirajući zahvat pri kojem su se uklanjale brojne strukture vrata, što je znatno narušavalo kvalitetu života pacijenata nakon operacije. Zahvaljujući velikom trudu akademske zajednice, disekcija vrata s vremenom je evoluirala u
manje invazivan postupak. Danas se teži što manjem opsegu zahvata uz očuvanje onkoloških ishoda, pa su tako razvijene
selektivne i superselektivne disekcije. Kao budućnost disekcije istražuju se robotski asistirani i endoskopski zahvati. Unatoč napretku onkoterapije, disekcija i dalje ostaje jedan od glavnih terapijskih modaliteta za lokalno proširenu bolest. Osim u terapiji, disekcija ima iznimno važnu ulogu i u stagingu primarnog karcinoma, budući da još uvijek ne postoji dovoljno osjetljiva tehnika
koja bi omogućila vizualizaciju okultnih metastaza u limfnim čvorovima.

Abstract (english)

The head and neck encompass some of the most complex anatomical regions in the body, with a high concentration of vital structures in a confined space. Understanding the anatomy and lymphatic system is crucial for comprehending the spread of cancer in the neck region and for successfully performing therapeutic procedures. Most squamous cell carcinomas of the head and neck are at least potentially curable. Primary carcinomas originating in most parts of the head and neck typically metastasize regionally to the cervical lymph nodes. The condition of these lymph nodes is the most important independent prognostic factor in head and neck cancer, making proper management of the cervical lymph nodes crucial for disease control. In fact, in cases where only one lymph node is pathologically positive, the five-year survival rate drops to 50%. Before the revolutionary development of neck dissection, head and neck cancers were considered an inevitably fatal diagnosis. Neck dissection became the standard surgical procedure for removing cancer from regional lymph nodes in the 19th century. The goal is to remove lymph nodes that are affected or at risk of being affected by metastases. Since its inception, neck dissection has undergone numerous modifications. Initially, it was an extremely mutilating procedure that
involved removing many structures in the neck, which significantly diminished the quality of life for patients postoperatively. Thanks to the significant efforts of the academic community, neck dissection has evolved over time into a less invasive procedure. Today, the focus is on minimizing the extent of the procedure while maintaining oncological outcomes, leading to the development of selective and superselective dissections. For the future, robotic-assisted and endoscopic procedures are being explored as potential advancements in dissection. Despite progress in oncotherapy, dissection remains one of the main therapeutic modalities for locally advanced disease. In addition to its therapeutic role, dissection is extremely important for staging primary carcinomas, as there is still no sufficiently sensitive technique available to visualize occult metastases in the lymph nodes.

• Keywords: Vrat; glava; disekcija; karcinom; terapija
• Keywords (english): Neck; head; dissection; carcinoma; therapy
• Language: croatian
• URN:NBN: urn:nbn:hr:105:645914
• 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: 2024-09-08 13:15:09