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Bruce J. Davidson, MD; Kenneth A. Newkirk, MD; K. William Harter, MD; Catherine A. Picken, MD; Kevin J. Cullen, MD; Roy B. Sessions, MD

Arch Otolaryngol Head Neck Surg. 1999;125:401-405.

Objective  To report the complication rate from planned, posttreatment neck dissections in patients who show control of primary squamous cell carcinoma by chemotherapy and radiotherapy or radiotherapy alone.

Design  Retrospective review of case series.

Setting  Georgetown University Medical Center, Washington, DC.

Patients  Thirty-four patients with clinically positive neck disease treated with organ preservation therapy for squamous cell carcinoma of the head and neck.

Interventions  Planned neck dissection after treatment with chemotherapy and radiotherapy or radiotherapy alone.

Main Outcome Measure  Perioperative complications.

Results  Forty-one neck dissections were performed on 34 patients. Complications were seen in 13 (38%) of 34 patients and 15 (37%) of 41 neck dissections. Wound complications occurred in 9 (22%) of 41 dissections. Neck dissection complication rate did not correlate with previous use of chemotherapy or with the use of brachytherapy at the primary site at the time of the neck dissection. Preoperative radiotherapy dose greater than 70 Gy was associated with complications in 58% vs 29% when preoperative dose was less than 70 Gy (P=.09). This trend was reflected primarily in wound complications (42% vs 14%; P=.10) and reached significance for skin flap necrosis (33% vs 0%; P=.005). Other factors that were associated with increased complications were preoperative albumin level less than 38 g/L and early neck drain removal.

Conclusions  The complication rate associated with planned posttreatment neck dissection is similar to that previously reported for neck dissection. Wound complications are more common when higher preoperative radiotherapy doses are used.

From the Departments of Otolaryngology–Head and Neck Surgery (Drs Davidson, Newkirk, Picken, and Sessions) and Radiation Medicine (Dr Harter), and the Division of Hematology/Oncology (Dr Cullen), Lombardi Cancer Center, Georgetown University Medical Center, Washington, DC. Dr Sessions is now with the Department of Otolaryngology–Head and Neck Surgery, Beth Israel Medical Center, New York, NY.

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