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Results of selective neck dissection in management of the node-positive neck
Peter E Andersen1, Frank Warren, Jeffrey Spiro
1Department of Otolaryngology/Head and Neck Surgery, Oregon Health Sciences University, Portland 97201, USA.
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.
Insights
Selective neck dissection shows promise for node-positive head and neck cancer patients. This study found high regional control rates, supporting its use in carefully selected cases.
Area of Science:
- Oncology
- Head and Neck Surgery
Background:
- Selective neck dissection (SND) is increasingly accepted for N0 necks.
- Its use in node-positive squamous cell carcinoma of the head and neck (HNSCC) remains controversial.
Purpose of the Study:
- To evaluate the oncologic efficacy of SND in patients with node-positive HNSCC.
- To determine if SND can achieve comparable regional control rates to comprehensive neck dissections.
Main Methods:
- Retrospective chart review of 106 previously untreated, node-positive HNSCC patients.
- Analysis of 129 selective neck dissections performed at three tertiary care centers.
- Minimum follow-up of 2 years or until death.
Main Results:
- 58% of patients were clinically staged as N1.
- Extracapsular extension was present in 34% of patients.
- A regional control rate of 94.3% was achieved with SND, with only 6 recurrences in the dissected neck side.
Conclusions:
- SND is oncologically effective in carefully selected node-positive HNSCC patients.
- Regional control rates with SND can be comparable to comprehensive neck dissections.
- Supports the judicious use of SND in specific HNSCC patient populations.