Laser Ablation of Metastatic Lymph Nodes in the Neck for Oral Carcinoma-Technique and Viability of the Procedure
Author(s): Rusy Bhalla, Seemantini Bhalla, Duleep Bhonsale, Ashish Kapadia
Background: Presence of macro and microdisease in the neck in cases of Oral carcinoma is a major barrier in full recovery of the patient. Conventionally the problem has been handled by Neck dissection popularly referred to as Radical Neck dissection and its many variants like Modified neck dissection and supraomohyoid dissection. The surgery assumes that removal of the fat containing lymph nodes is effective in spread of the disease. The major stumbling block is presence of extra nodal spread in enlarged lymph nodes. Percutaneous lymph node laser ablation (PLALN) is becoming more popular in many centers for necrosing the lymph nodes effectively without the neck dissection. There are obvious advantages and disadvantages to this procedure. This study was aimed at verifying the effectiveness of the procedure and aimed to understand the reason for success and failure if any. Attempt has also been made to understand the Anatomy of Neck Lymphatic system and understand the cellular structure of lymph nodes which would make the procedure effective.
Patients and Methods: 46 patients were of oral carcinoma were included in this observational study. These patients were having Metastatic lymph nodes on Ultrasonography and MRI scans prior to the procedure. The primary tumours were handled by Laser ablation and PLALN was carried out as a part of the procedure.
Results: The procedure was safe and effective in 100 % of cases in necrosing the lymph nodes less than 2.0 cms in longest diameter. It was 70% effective in handling lymph nodes more than 2.0 cms in diameter. It was less than 20% effective in handling lymph nodes more than 3.5 cms in diameter. There was no major side effect of the procedure in any patient.
Conclusion: PLALN is an effective procedure for handling of Metastatic lymph nodes in early stages.