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John W. Werning, MD, DMD; Diana Heard, MD; Cassandra Pagano, BA; Sadik Khuder, PhD

Arch Otolaryngol Head Neck Surg. 2003;129:83-88.

Background  The treatment of patients with squamous cell carcinoma of the head and neck who have a clinically negative (cN0) neck remains controversial. Furthermore, the treatment delivered to patients with a cN0 neck by practicing otolaryngologists is not known.

Objective  To determine the variability in the management of the cN0 neck in the otolaryngology community.

Design, Setting, and Participants  A random survey of 763 board-certified otolaryngologists in the United States.

Main Outcome Measures  Physician respondents' preferences for observation vs treatment of the cN0 neck and the treatment modalities chosen.

Results  Forty-one percent of the surveyed physicians responded. Nearly 10% of the respondents observed all patients with a cN0 neck. Otolaryngologists who treat 35 or more new patients with cancer each year were more likely to perform elective treatment of the neck for a T2 lesion of the oral tongue than those who treat 10 or fewer patients each year (P = .03). They were also more likely to treat patients with a cN0 neck when the risk of occult cervical metastases was greater than 15% to 20% (P = .04). A comprehensive neck dissection was the preferred lymphadenectomy procedure for 21% of the otolaryngologists surveyed.

Conclusions  Variations in the treatment of the cN0 neck are associated with differences in the frequency of treatment of patients with head and neck cancer by otolaryngologists. Uniformity of care must be established within the otolaryngology community by developing widely accepted evidence-based guidelines and referring patients to surgeons who routinely treat head and neck cancer.

From the Department of Otolaryngology, University of Florida, Gainesville (Dr Werning); and the Departments of Otolaryngology–Head and Neck Surgery (Dr Heard and Ms Pagano) and Medicine (Dr Khuder), Medical College of Ohio, Toledo.

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