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Complications from planned, posttreatment neck dissections
B J Davidson1, K A Newkirk, K W Harter
1Department of Otolaryngology-Head and Neck Surgery, Lombardi Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA. davidsob@gunet.georgetown.edu
Archives of Otolaryngology--Head & Neck Surgery
|April 20, 1999
Summary
Planned neck dissections after head and neck cancer treatment have a similar complication rate to standard dissections. Higher preoperative radiation doses increase the risk of wound complications and skin flap necrosis.
Area of Science:
- Oncology
- Head and Neck Surgery
- Radiation Oncology
Background:
- Squamous cell carcinoma of the head and neck is often treated with organ preservation therapy, involving chemotherapy and radiotherapy.
- Posttreatment neck dissection is sometimes performed to manage clinically positive neck disease after initial treatment.
Purpose of the Study:
- To determine the complication rate of planned, posttreatment neck dissections following organ preservation therapy for head and neck squamous cell carcinoma.
- To identify factors associated with increased complications in these procedures.
Main Methods:
- Retrospective review of a case series of 34 patients with head and neck squamous cell carcinoma and clinically positive neck disease.
- Analysis of perioperative complications following planned neck dissections after chemotherapy and radiotherapy or radiotherapy alone.
Main Results:
- A total of 41 neck dissections were performed, with an overall complication rate of 38% (13/34 patients).
- Wound complications occurred in 22% (9/41 dissections).
- Higher preoperative radiotherapy doses (greater than 70 Gy) were associated with a trend towards increased overall complications (58% vs 29%) and significantly higher rates of skin flap necrosis (33% vs 0%). Lower preoperative albumin levels and early drain removal were also linked to increased complications.
Conclusions:
- The complication rate for planned posttreatment neck dissection is comparable to historical data for standard neck dissections.
- Higher preoperative radiotherapy doses are a significant risk factor for wound complications, particularly skin flap necrosis, in patients undergoing posttreatment neck dissection.