Neck dissection: radical or conservative

Four hundred and forty-five neck dissections for epidermoid carcinoma over a 10-year period are reviewed as to local recurrence of neck disease. Three hundred and forty-seven dissections were radical en bloc procedures and in 98 a modified conservative technique was utilized. Cervical lymph node classification was applied and a comparison made of the two techniques. A review of the anatomy of cervical fascias and the technique of conservative neck dissection is given. Evaluation of this series of cases indicate that the control of local disease in the neck in the N0 and N1 groups is is accomplished as well with conservative dissection as with radical neck dissection. The number of conservative neck dissections for N2 disease was too limited for accurate comparison. There were no conservative neck dissections done for N3 disease. We suggest that conservative neck dissection be utilized for subclinical and N1 disease and that the classic en bloc dissection be reserved for N2 and N3 situations.