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2b or not 2b? Shoulder function after level 2b neck dissection: A double-blind randomized controlled clinical trial.

Peter T Dziegielewski1,2,3, Margaret L McNeely4, Nigel Ashworth5

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Omitting level 2b in selective neck dissection (SND) significantly improves shoulder function and quality of life for head and neck cancer patients. This modification reduces spinal accessory nerve (SAN) injury without compromising oncological outcomes.

Keywords:
head and neck cancerneck dissectionquality of lifeshoulder dysfunctionshoulder syndromespinal accessory nerve

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Area of Science:

  • Oncology
  • Surgical Innovation
  • Neurosurgery

Background:

  • Selective neck dissection (SND) is crucial for head and neck cancer treatment.
  • Spinal accessory nerve (SAN) trauma during SND can lead to shoulder syndrome.
  • The impact of limited level 2 dissection on SAN injury is not well-established.

Purpose of the Study:

  • To evaluate if omitting level 2b dissection in SND improves shoulder-related quality of life and function.
  • To assess the effect of modified SND on spinal accessory nerve (SAN) function.

Main Methods:

  • A double-blind randomized controlled trial comparing SND with and without level 2b dissection.
  • Patients with head and neck cancers were randomized (1:1) to either group.
  • Primary outcome: change in Neck Dissection Impairment Index (NDII) at 6 months; secondary outcomes: shoulder strength, range of motion (ROM), and SAN nerve conduction.

Main Results:

  • Patients undergoing SND without level 2b dissection showed a significantly greater improvement in NDII scores.
  • Significant declines in shoulder ROM and SAN conduction were observed in the group with level 2b dissection.
  • No adverse events were reported in either group.

Conclusions:

  • Omitting level 2b dissection in SND is recommended when oncologically safe and feasible.
  • This approach optimizes the balance between functional preservation and cancer cure.
  • Minimizing SAN trauma through modified dissection techniques enhances patient outcomes.