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Implications for Selective Neck Dissections

Ranjiv Sivanandan, MD, FRCS; Michael J. Kaplan, MD; Kimberly J. Lee, MD; Darren Lebl, MS; Harlan Pinto, MD; Quyhn-Thu Le, MD; Don R. Goffinet, MD; Willard E. Fee, Jr, MD

Arch Otolaryngol Head Neck Surg. 2004;130:1369-1373.

Objective  The optimal surgical procedure for the neck in patients with squamous head and neck cancers is controversial. Selective neck dissections have replaced modified radical neck dissections as the procedure of choice for the clinically negative (N0) neck and are now being considered for patients with early-stage neck disease. We report the long-term local recurrence rates in 100 consecutive patients undergoing a radical or modified radical neck dissection for clinically positive (N+) and N0 neck disease and review comprehensively the literature reporting and comparing regional control rates for both neck dissection types.

Patients  The clinical records of 100 consecutive patients who underwent a comprehensive neck dissection (levels I-V) for squamous head and neck cancers with a minimum of a 2-year follow-up were retrospectively reviewed for primary site of disease, clinical and pathologic neck status, histopathologic grade, neck dissection type, and the site and time of recurrence.

Results  Complete data were available for 97 patients on whom 99 neck dissections were performed. Three patients died from unknown causes. Seventy-six patients with N+ disease underwent a therapeutic neck dissection, while 24 patients with clinically N0 disease underwent an elective dissection. The overall neck recurrence rate in patients with controlled primary disease was 7%. The neck or regional failure rate for patients completing the recommended adjuvant radiotherapy was 4%. Six (25%) of 24 patients with clinically N0 disease had occult metastases. The recurrence rate for this group was 4%.

Conclusion  Further study is needed to determine the optimal surgical management of the N0 and limited N+ neck.

Author Affiliations: Departments of Otolaryngology–Head and Neck Surgery (Drs Sivanandan, Lee, Kaplan, and Fee), Medical Oncology (Dr Pinto), and Radiation Oncology (Drs Quyhn-Thu Le and Goffinet), Stanford University Hospital, and Stanford University School of Medicine (Mr Lebl), Stanford, Calif.

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