title: Pattern of lymphatic spread from carcinoma of the buccal mucosa and its implication for less than radical surgery.
abstract: OBJECTIVE
  With emerging evidence, focus is shifting to conservative neck procedures aimed at achieving good shoulder function without compromising oncologic safety.
  
  
  METHODS
  Retrospective analysis of 100 consecutive neck dissections for carcinoma of the buccal mucosa was carried out to evaluate the pattern of lymphatic spread. Pathologic results were correlated with clinical/radiologic findings. Survival was calculated with the Kaplan-Meier method and log-rank test.
  
  
  RESULTS
  Only 36 patients were found to harbor metastasis in the lymph nodes on pathologic examination. Most of these were present in levels I and II only. Skip metastasis was not detected in any patient. None of the patients was found to have involvement of level V nodes, whereas 1 patient had involvement of level IV. Thirty-four patients developed recurrences; 3-year disease-free survival was 48%.
  
  
  CONCLUSIONS
  Lymphatic spread from carcinoma of the buccal mucosa is low. Involvement of level IV is seen in only 1% of patients. A more conservative approach to the neck in patients with carcinoma of the buccal mucosa is recommended.
authors.affiliation: Department of Surgical Oncology, Banaras Hindu University, Varanasi, India. manojpandey@vsnl.com
authors.forename: Manoj
authors.initials: M
authors.lastname: Pandey
authors.forename: Mridula
authors.initials: M
authors.lastname: Shukla
authors.forename: C S
authors.initials: CS
authors.lastname: Nithya
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology* / Q000601:surgery; D037981:Neck Dissection / Q000379:methods*; D009334:Neck Muscles / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D010369:Pectoralis Muscles / Q000637:transplantation; D011237:Predictive Value of Tests; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016038:Skin Transplantation; D013524:Surgical Flaps; D015996:Survival Rate; D014057:Tomography, X-Ray Computed