Is modified radical neck dissection only a staging procedure?

This retrospective study evaluates the clinical benefit of modified radical neck dissection among patients with squamous carcinoma of the upper aerodigestive tract. Ninety-eight modified neck dissections were performed in 86 patients over a 5-year period. The procedure entailed removal of the submaxillary and jugular chain nodes while the posterior triangle was not dissected. Thirty-two patients received postoperative radiotherapy. Lymph nodes were histologically positive in 55 of 98 dissections (56%). Among 72 determinate patients, recurrence in the dissected neck occurred in 8 of 38 with positive nodes and none of 34 with negative nodes (P less than 0.05). These recurrences occurred in patients who had clinically palpable nodes preoperatively. Postoperative radiotherapy did not significantly alter the overall recurrence rate or survival of patients with positive nodes. Cumulative disease-free survival at 5 years was 70% overall. It is concluded that the modified neck dissection described is appropriate in the clinically negative neck or when regional disease is early (i.e., N1) and located in the submandibular triangle. Postoperative radiotherapy should be given if more than one node is involved histologically or if extracapsular spread is present.