Management of the node-positive neck in oral cancer

Surgery continues to play a prominent role in the management of patients with loco-regionally advanced squamous cell carcinoma of the upper aerodigestive tract. Most evidence supports the use of comprehensive neck dissection for node-positive disease and suggests that planned neck dissection following definitive radiation therapy and chemoradiation therapy is unnecessary in the great majority of patients with node-positive neck disease who exhibit a complete response. Evidence for less aggressive therapy is much less compelling in patients with bulky adenopathy. For such patients, there is growing enthusiasm for selective or even super-selective neck dissection for surgical salvage. Finally, when cervical disease is so advanced as to involve the carotid artery, evidence continues to portend a dismal prognosis.