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Peter E. Andersen, MD; Frank Warren, MD; Jeffrey Spiro, MD; Alan Burningham, MD; Richard Wong, MD; Mark K. Wax, MD; Jatin P. Shah, MD; James I. Cohen, MD, PhD

Arch Otolaryngol Head Neck Surg. 2002;128:1180-1184.

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.

From the Department of Otolaryngology/Head and Neck Surgery, Oregon Health Sciences University, Portland (Drs Andersen, Warren, Burningham, Wax, and Cohen); University of Connecticut Health Center, Farmington (Dr Spiro); and the Memorial Sloan-Kettering Cancer Center, New York, NY (Drs Wong and Shah).

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