147 / 220
a reduced in-patient stay supports the economic argu-
ment for SNB over END
[28]
.
The identification of aberrant drainage patterns is a
huge advantage of SNB and will also have application in
patients with second primary tumours where a neck
dissection has already been performed and drainage has
been disturbed. The disadvantage of blanket ipsilateral
END is illustrated in the study of pN0 necks treated by
END
[21]
. In this series, the regional recurrence rate of
18% seems high but it is worth noting that in over one-
third of patients (39%) recurrence occurred in the
contralateral neck. One further advantage of SNB is that
because the tissues have not been significantly disturbed,
comprehensive salvage surgery is possible if a recurrence
is detected promptly. Our results have also shown that
the metastasis type (ITC, micrometasis, macrometastasis)
was a prognostic value for overall survival. This confirms
recent findings
[29,30]
and may be important for strati-
fying personalised treatment in the future.
At the present time, SNB is not widely recognised as
standard care in early oral and oropharyngeal cancer.
However, increasingly it is gaining utility in Europe and
in some countries, such as Denmark, it is integrated into
the standard care pathway. Data emerging from this
study are relevant to the evolving therapeutic use of
SNB technique and provide data to support further
investigation by prospective randomised trials. The
drive towards patient-specific and minimally invasive
surgery is further refining the SN technique and we
expect that the use of intraoperative 3D navigation
[31]
,
new tracers
[32]
and fluorescent markers
[33]
will
improve the ease and accuracy of sampling sentinel
lymph nodes. SNB potentially offers the solution to the
dilemma ’How do you manage the N0 neck?’
Presentations of this work
Part of this work has been presented by members of the
Sentinel European Node Trial (SENT) group at meet-
ings of the European Association of Craniomaxillofacial
Surgery, The American Head and Neck Society, the
European Congress of Pathology, the International
Association of Oral and Maxillofacial Surgery, and the
British Association of Oral and Maxillofacial Surgeons
as well as our annual SENT group meetings, part of the
International Symposium on metastasis in head and
neck cancer.
Disclaimers
None.
Conflict of interest statement
The authors confirm that there is no conflict of in-
terest in relation to this publication.
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