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Evolution of the clinically negative neck

E M Skolnik, A H Katz, S P Becker

    The Annals of Otology, Rhinology, and Laryngology
    |November 1, 1980
    PubMed
    Summary
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    For upper aerodigestive tract cancers with no clinically positive neck nodes, elective neck dissection did not significantly alter recurrence rates compared to observation. Further analysis is needed for optimal management strategies.

    Area of Science:

    • Head and Neck Oncology
    • Surgical Oncology
    • Cancer Research

    Background:

    • Primary squamous cell carcinoma of the upper aerodigestive tract often presents with clinically negative neck nodes (N0).
    • Treatment strategies for the N0 neck during 1960-1975 varied, including elective neck dissection or clinical observation.
    • This retrospective study leverages this historical variation to compare outcomes.

    Purpose of the Study:

    • To evaluate the impact of elective neck dissection versus observation on cervical recurrence rates in patients with primary upper aerodigestive tract squamous cell carcinoma and clinically negative neck nodes (N0).
    • To analyze factors influencing the development of palpable nodal disease.
    • To correlate neck specimen histology with recurrence rates.

    Main Methods:

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  • Retrospective analysis of 602 patients with N0 primary squamous cell carcinoma of the upper aerodigestive tract treated between 1960-1975.
  • Patients were divided into two groups: primary surgery only (Group 1, n=149) and primary surgery with immediate radical neck dissection (Group 2, n=253).
  • Analysis of cervical recurrence rates, development of palpable nodal disease, and correlation with primary tumor control and histopathological findings.

    • Main Results:

    • Group 1 (observation) had 12.9% recurrence, while Group 2 (elective neck dissection) had 22% palpable nodal disease.
    • Only 3% of patients developed lymph node metastases when the primary tumor was controlled.
    • Histologically positive nodes showed a 23% failure rate, and negative nodes showed a 21% failure rate; the number of positive nodes did not significantly impact recurrence.

    Conclusions:

    • Elective neck dissection did not demonstrate a significant benefit in reducing cervical recurrence rates compared to observation in this historical cohort of N0 upper aerodigestive tract squamous cell carcinoma.
    • Primary tumor control appears crucial in preventing lymph node metastasis.
    • Histological status of nodes, regardless of number, showed similar recurrence rates, suggesting a complex interplay in disease progression.