Results of selective neck dissection in management of the node-positive neck

Arch Otolaryngol Head Neck Surg. 2002 Oct;128(10):1180-4. doi: 10.1001/archotol.128.10.1180.

Abstract

Background: Although increasingly accepted in treatment of the N0 neck, use of selective neck dissection in patients with node-positive squamous cell carcinoma of the head and neck remains controversial.

Objective: To determine the oncologic efficacy of selective node dissection in patients with node-positive squamous carcinoma of the head and neck.

Setting: Three tertiary care academic/Veterans Affairs medical centers.

Methods: Ten-year retrospective medical chart review of 106 previously untreated clinically and pathologically node-positive patients undergoing 129 selective neck dissections and followed for a minimum of 2 years or until patient death.

Results: Regional metastasis was clinically staged as N1 in 58 patients (54.7%), N2a in 5 (4.7%), N2b in 28 (26.4%), N2c in 14 (13.2%), and N3 in 1 (0.9%). Extracapsular extension of tumor was present in 36 patients (34.0%), and postoperative radiation therapy was administered to 76 patients (71.7%). Overall, 9 patients experienced disease recurrence in the neck. Six of these recurrences were in the side of the neck that had undergone selective neck dissection, for a regional control rate of 94.3%.

Conclusions: These results support the use of selective neck dissection in carefully selected patients with clinically node-positive squamous cell carcinoma of the head and neck region. Regional control rates comparable to those achieved with comprehensive operations can be achieved in appropriately selected patients.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell / mortality
  • Carcinoma, Squamous Cell / secondary*
  • Carcinoma, Squamous Cell / surgery*
  • Female
  • Follow-Up Studies
  • Head and Neck Neoplasms / mortality
  • Head and Neck Neoplasms / pathology*
  • Head and Neck Neoplasms / surgery*
  • Humans
  • Lymph Node Excision*
  • Lymphatic Metastasis / pathology*
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / mortality
  • Neoplasm Recurrence, Local / pathology*
  • Neoplasm Staging
  • Outcome Assessment, Health Care*
  • Retrospective Studies
  • Survival Rate
  • Time Factors