Spinal accessory lymph nodes: a prospective study of metastatic involvement

Area of Science:

• Oncology
• Head and Neck Surgery
• Surgical Anatomy

Background:

• Radical neck dissection (RND) traditionally excises the spinal accessory nerve (SAN) to remove all lymph node tissue.
• This approach can lead to decreased range of motion and pain in the affected extremity.
• Alternative surgical strategies are being explored to mitigate these functional deficits.

Purpose of the Study:

• To prospectively evaluate the frequency of metastatic involvement in spinal accessory lymph nodes (SALNs) within radical neck specimens.
• To determine if SALN involvement justifies the functional morbidity associated with SAN sacrifice during RND for head and neck malignancies.

Main Methods:

• Prospective review of 50 radical neck dissection specimens.
• Analysis of metastatic involvement in SALNs and comparison with overall nodal involvement in the neck specimen.
• Detailed mapping of the location of any cancerous involvement along the SAN.

Main Results:

• The frequency of cancerous involvement in SALNs was not significantly different from the overall nodal involvement in the neck specimen.
• Metastatic involvement of the SAN was predominantly located in its proximal portion, outside the posterior triangle.
• The findings suggest that SALNs are frequently involved in head and neck cancers.

Conclusions:

• Preservation of the spinal accessory nerve cannot be justified solely on the basis of infrequent metastatic involvement.
• The study challenges the rationale for routine SAN sacrifice in RND when SALNs are frequently involved.
• Further research may explore tailored surgical approaches balancing oncologic control and functional preservation.