[Neck dissection-more, less, targeted?]

Neck dissection is an essential part of surgical treatment for head and neck malignancies. In recent years, the extent of neck dissection required for optimal oncological results has been increasingly reduced and, in some cases, replaced by alternative procedures such as sentinel lymph node biopsy. However, this is only possible with precise staging. Improved imaging, molecular markers, and artificial intelligence are used for this purpose. Particularly in light of immunotherapy, which has now also been approved for neoadjuvant use, the preservation of functional lymphatic structures is relevant, as this has a positive effect on the response to treatment. Ultimately, histological examination of the cervical lymph nodes remains the gold standard for assessing prognosis and planning adjuvant therapy.