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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
PubMed
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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.

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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.