Bilateral radical neck dissections

Of 697 patients undergoing radical neck dissection for head and neck cancer, 91 (13%) had bilateral radical neck dissection. No operative deaths occurred. The complication rate was least for staged second neck dissections (17 patients). While overall surgical and medical complication rates for simultaneous bilateral neck dissections (11 patients) were greater than those after staged and delayed (53 patients) neck dissections, surgical complication rates alone for these three groups were comparable. The combined group of patients treated aggressively by simultaneous or staged second neck dissection had no greater complication rate than patients (ten) treated by second neck dissection when metastasis became clinically evident later. These findings and evidence that 55% of these patients were alive after five years or died of unrelated causes encourage us to support more aggressive surgical therapy in patients with manifest or likely occult bilateral metastases from a head and neck primary carcinoma.