Neck dissection for cancer

Control of metastatic disease in the neck is only a part of the spectrum of treatment of a patient with head and neck cancer. Concepts as to how to manage both the primary cancer and the possible metastases in the neck are constantly changing, and new combinations are being proposed almost daily. This article focuses mainly on the various surgical procedures that have been advocated in an attempt at controlling metastatic disease in the neck. The author has not considered the role of control of the primary cancer nor the significance of distant metastases in the rate of survival of patients with head and neck cancer. The frequency with which patients with cancer of the upper aerodigestive system develop second primaries indicates that we are only dealing with a portion of the problem. We have no way of reversing the premalignant changes that have probably developed in the epithelial surface of the smokers/alcoholics who constitute such a large percentage of the patients with whom we deal.