Lymphedema Severity and Quality of Life as a Function of Selective Neck Dissection Technique

Combined lymphatic and venous insufficiency has been described as a consequence of lymph node dissections, but never in the context of selective neck dissections (SND). The objective of this retrospective cohort study was to compare two methods of SND: one (PEF), which preserves the facial vein (FV) and external jugular vein (EJV), and one (REF), which resects the FV and often the EJV.

Head and neck lymphedema was assessed with a modified external lymphedema-fibrosis scale and with the revised Patterson Scale (internal lymphedema). The FACT-HN questionnaire was used to assess quality of life (QoL). Regression modeling was used to determine the effect of the SND technique on lymphedema, controlling for other factors.

A total of 79 patients were included in the analysis, with 60 (75.9%) PEF patients and 19 (24.1%) REF. There were no statistically significant differences in demographics or adjuvant therapy between the two treatment groups. The average score for QoL out of a possible 108 was 94.1 ± 10.4 for PEF and 88.3 ± 11.6 for REF (p = 0.043); regression analysis with covariates showed no significant associations with QoL (p = 0.113). REF patients were observed to have significantly higher external lymphedema scores compared to PEF patients (OR: 2.82, 95% CI: 1.00-8.02; p = 0.049). There were no significant differences in internal lymphedema scores between PEF and REF patients.

Results of this study showed resection of the FV and EJV was associated with more severe external lymphedema. A larger study that investigates differences in lymphedema between different SND techniques may therefore be warranted.

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