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PubMed1988

Radical neck dissection: is it enough?

This series of 307 patients who underwent radical neck dissection showed an overall recurrence rate of 19 percent. Clinical staging of disease was an accurate predictor of both recurrence and survival. Extranodal disease dramatically increased recurrence and decreased survival. Although our recurrence rate after radical neck dissection was lower than that previously reported for surgery alone, it was still significantly higher than that after adjuvant radiotherapy. We conclude that histologically proved neck disease should be treated by radical neck dissection, followed by adjuvant radiotherapy to decrease recurrence and, it is hoped, improve survival.

Aged↗
PubMed2004

Routine inclusion of level IV in neck dissection for squamous cell carcinoma of the larynx: is it justified?

BACKGROUND: Dissection of levels II-IV as part of an elective or therapeutic neck dissection is common practice during laryngectomy for laryngeal squamous cell carcinoma (SCC). The necessity of routine dissection at level IV has recently been questioned. The purpose of this study was to find the incidence of level IV metastases in patients with transglottic and supraglottic SCC who underwent neck dissections. METHODS: The charts of 71 suitable patients were reviewed. Forty-two had supraglottic primary cancers, and 29 had transglottic primary tumors. Levels II-IV had been removed in them all, and their neck specimens were marked according to the levels of the neck. The surgical specimens were pathologically diagnosed. RESULTS: Of 43 patients who underwent elective lateral neck dissection, the only one (2.3%) with level IV metastases also showed metastases at level II. Nine (32%) of the other 28 patients with clinical adenopathy had level IV metastases. CONCLUSIONS: Dissection of level IV as part of a therapeutic neck dissection for supraglottic and transglottic SCC is recommended for patients with clinically enlarged lymph nodes, but its necessity in the absence of detectable adenopathy is challenged.

Adult↗
PubMed1985

Modified radical neck dissection for metastatic carcinoma of the thyroid. A reappraisal.

From January 1958 through December 1983, 56 modified radical neck dissections were performed on 47 patients with metastases to the cervical nodes from differentiated carcinomas of the thyroid. In nine patients, a second modified radical neck dissection was performed either simultaneously or at a later date. Lymph node clearance was performed on all but one surgical specimen. The number of nodes in each specimen ranged from 10 to 96, and the number of involved nodes ranged from 1 to 20. Thirty-eight of the 56 neck specimens contained four or more positive nodes. Seventeen patients were followed for 10 to 26 years, 18 patients for 5 to 9 years, and 5 patients for less than 5 years. Seven other patients died, three from other causes and four from lung metastases. There were no recurrences in the neck sides that would have been cleared if standard radical neck dissection had been performed. This reappraisal with long-term follow-up supports our initial impression that a modified radical neck dissection sparing the spinal accessory nerve, the sternocleidomastoid muscle, the internal jugular vein, or any combination thereof is an effective procedure for differentiated cancer of the thyroid, with preservation of good shoulder function and improvement in the cosmetic appearance of the neck.

Adenocarcinoma↗
PubMed2003

Amputation neuromas after neck dissection.

OBJECTIVE: We sought to define the incidence of neuroma formation after neck dissection in a large series of patients. METHODS: One hundred fifty-three patients who were seen during a 2-year period (followed for 3 months to 10 years; mean, 52 months) were evaluated for neuroma formation after neck dissection (185 procedures). Cut nerve edges were not routinely ligated or cauterized. RESULTS: Operative records indicated that except for 4 cases, the stumps of the great auricular nerve and cervical branches were left intact after resection. No cases of palpable neuromas were found. In one case of a revised neck, a small macroscopically indiscernible nodule was histologically defined as neuroma. CONCLUSION: No neuromas were discovered in our series of neck dissection cases. If found, it is imperative these lesions be differentiated from recurrent cancer. Our results do not support any interference with cut nerve edges.

Adult↗
PubMed1988

Modified neck dissection in treatment of thyroid cancer: a safe procedure.

Differentiated carcinoma of the thyroid metastasizes early and frequently to cervical lymph nodes. Radical neck dissection performed electively or therapeutically results in high cure rates. Modified neck dissection consisting of a single transverse incision, resection of the jugular chain of nodes and those in the posterior triangle of the neck with preservation of the sternomastoid muscle, the spinal accessory nerve and the submandibular salivary gland provides a cosmetic, functional result with minimal morbidity. In a series of 313 neck dissections for thyroid carcinoma, only three patients with papillary or follicular carcinoma, which was resectable, treated by thyroidectomy and modified neck dissection died of disease.

Adolescent↗
PubMed2002

Outcome of neck dissection for node-positive melanoma.

OBJECTIVE: To determine the rates of regional recurrence for node-positive melanoma after neck dissection alone. DESIGN: Retrospective review from a single tertiary care institution. METHODS: Data were obtained for all patients receiving neck dissection from 1990 to 1997 at Sunnybrook and Women's Health Sciences Center. Analysis was performed using the Kaplan-Meier method. RESULTS: Thirty-one patients underwent neck dissection for node-positive melanoma in the study period. The rate of regional recurrence was 31% at 5 years. The mean time to recurrence was 78 months. CONCLUSION: Neck dissection alone may be appropriate for some patients, but those with more advanced neck disease are likely to benefit from adjuvant radiotherapy.

Head and Neck Neoplasms↗
PubMed2002

A logical and stepwise operative approach to radical neck dissection.

A thorough understanding of the anatomy of the neck is essential to avoid injury to vital structures when performing radical neck dissection. The complicated anatomical relations of the various nerves, vessels, and muscles within the confined area of the neck can often be daunting. We outline strategic anatomical landmarks and their relationships to important nerves, arteries, veins, and lymphatics to simplify the complicated and formidable anatomy of the neck. We also delineate key maneuvers that, when combined with the anatomical landmarks, offer a stepwise and logical approach to performing radical neck dissection that confers improved safety.

Humans↗
PubMedDate not supplied

Reflex sympathetic dystrophy following neck dissections.

PURPOSE: Reflex sympathetic dystrophy (RSD), which is a disorder that occurs after injury or surgery on the extremities, has not been reported as a complication of neck dissections until now. A group patients with head and neck cancer have been examined to determine the incidence of RSD in neck dissections. PATIENTS AND METHODS: Forty-six patients with head and neck cancer, who had undergone neck dissections together with the removal of the primary tumor, were evaluated for RSD on their routine controls. RESULT AND CONCLUSION: The presentation of RSD in two patients who were treated with radical neck dissection is probably a result of sympathetic hyperactivity that is secondary to surgical trauma.

Accessory Nerve↗
PubMed1996

[Significance of sternocleidomastoid muscle resection in radical neck dissection].

Surgical therapy of cervical lymph node metastasis is based on their accessibility for en bloc resections. First described by Crile in 1906 as a radical neck dissection, this original approach has since undergone various modifications. This has produced an ongoing controversy with regard to the indications of the individual techniques. In a retrospective study, the data of 438 patients with head and neck malignancies managed at the ENT Department of Hamburg University between 1988 and 1994 were analyzed after surgical treatment of cervical lymph nodes. Results showed that 337 patients (76.9%) required unilateral or bilateral selective neck dissections. In 101 patients (23.1%) in whom a radical neck dissection was performed, the sternocleidomastoid muscle was resected completely. Analysis of these cases showed that intraoperative macroscopic invasion occurred in 12 patients (11.9%) and was confirmed histologically. The vast majority of cases (n = 89; 88.1%) had an intact muscle resected without tumor involvement. Further analysis showed no difference between radically or functionally neck-dissected stage III or IV patients with oral cavity, oropharyngeal, hypopharyngeal and laryngeal carcinomas. On the basis of these findings, resection of the sternocleidomastoid muscle is not mandatory in patients undergoing primary surgery without previous (cervical) radiation and when the muscle is found to be macroscopically intact.

Adult↗
PubMed1998

Histologic evaluation of neck dissection specimens.

Histologic evaluations of neck dissection specimens from carcinomas of the head and neck provide information required for disease staging, planning further treatment, and prognosis. Histologic evaluation performed adequately and accurately can and continues to provide a more accurate, meaningful, and promising means of formulating and predicting prognosis including risk of metastases. A multi-institutional study using comprehensive standardized histologic evaluation of histopathologic variables of primary tumor and cervical lymph nodes among homogenous patient groups receiving similar therapy is important. Histopathologic parameters remain an important adjunct parameter to clinical evaluation in guiding, planning treatment, and predicting prognosis for patients with head and neck cancers.

Carcinoma↗
PubMed2006

Planned post-chemoradiation neck dissection: significance of radiation dose.

OBJECTIVE: The increasing prominence of multimodality therapy for patients with advanced head and neck cancer reflects its high survival and functional preservation rates. We report the pathologic data on patients undergoing neck dissection (ND) after induction chemotherapy followed by concomitant chemoradiotherapy (IC-CRT) in three similar protocols utilizing decreasing doses of radiation therapy. MATERIALS AND METHODS: The databases of 221 patients who underwent IC-CRT between 1999 and 2002 were reviewed. Based on posttreatment residual or pretreatment N2a or greater neck disease, 73 patients without pretreatment neck surgery were eligible for analysis (1 N1, 3 N2a, 26 N2b, 20 N2c, 23 N3). Three additional subgroups were also analyzed with respect to outcome: Undissected patients with less than N2 disease, patients who had neck surgery prior to IC-CRT, and patients with N2a or greater neck disease who did not have post-IC-CRT ND. STUDY DESIGN: Retrospective analysis. RESULTS: Sixty-seven patients underwent unilateral or bilateral selective neck dissection. Six patients had modified or radical ND. There were no wound healing complications. Pathologic analysis revealed viable cancer in 15 of 73 patients (20.5%): 1 had N1, 3 had N2b, 4 had N2c, and 7 had N3 neck disease. The incidence of viable cancer in the neck dissection specimen increased as radiation dose decreased. Complete response induction chemotherapy predicted negative pathology (P = .003). In the subgroup analysis, patients who had pretreatment surgery had a lower risk of dying from the primary cancer CONCLUSIONS: 1) The incidence of positive pathology after IC-CRT increases as radiation dose decreases. 2) Selective neck dissection after CRT has been demonstrated to be feasible and safe; the complication rate of ND after IC-CRT is acceptably low. 3) There is viable posttreatment cancer in 20.5% of patients, indicating necessity of ND in these patients.

Adult↗
PubMed1997

[Clinical analysis of bilateral neck dissection in patients with laryngeal cancer].

The clinical materials of 54 cases with laryngeal cancer treated between 1980 and 1995 were retrospectively analysed. All patients had received bilateral neck dissection. The results indicated that if one internal jugular vein was preserved, bilateral neck dissection was safe and no fatal complications occur. In this series, most patients were of T3 and T4. The 3 and 5 year survival rates were 62% and 52% respectively. Cervical recurrence was the main reason for the deaths. It is suggested that for patients with advanced supraglottic laryngeal carcinoma, bilateral neck dissections are often needed, functional neck dissection, with preservation of at least one internal jugular vein is the best choice.

Adult↗
PubMed1983

Functional evaluation of the spinal accessory nerve after neck dissection.

The pain and dysfunction associated with a loss of innervation by the spinal accessory nerve has motivated surgeons to modify the classic radical neck dissection. A prospective study of 109 patients who underwent either a radical neck dissection or a modification of it with preservation of the spinal accessory nerve revealed that those patients in whom the nerve, muscle, and vein were preserved had less dysfunction (30 percent) than those with nerve preservation only (50 percent) or classic radical neck dissection (60 percent). In addition, even when the functional disability was the same, there was less associated pain with nerve-sparing procedures. Furthermore, a large group of patients (40 percent) who underwent classic radical neck dissection had minimal disability. Given these results, a prospective study of recurrence data in these patients is indicated.

Accessory Nerve↗
PubMed2002

[Effectiveness of neck dissection in metastasizing mouth carcinoma. Uni- and multivariate analysis of factors of influence].

BACKGROUND: The purpose of this study was to evaluate the oncologic effectiveness of radical and different types of modified neck dissections with preservation of n. accessorius, v. jugularis interna, and m. sternocleidomastoideus and to identify prognostic factors for regional control and survival in univariate and multivariate analysis. METHODS: This retrospective study included 373 patients with squamous cell carcinoma of the oral cavity who underwent 401 neck dissections between January 1986 and December 1995 at the Department for Oral and Maxillofacial Surgery, Hanover Medical School. RESULTS: The 5-year regional control was estimated at 87%. Relapse occurred only within the first 2 years after neck dissection. The number of positive nodes, metastases without lymphatic tissue, preparation of metastases from the carotid artery and cranial base, and preoperative radiochemotherapy were analyzed as prognostic factors with significant influence. The grade of metastases, extracapsular spread, lymphangiosis carcinomatosa, and postoperative radiation showed no prognostic significance. DISCUSSION: The comparison of recurrent metastases after radical and modified neck dissection demonstrated that as the extent of neck disease increased there was a tendency toward improved regional control after radical neck dissection.

Adult↗
PubMed2002

Carcinoma of the supraglottic larynx: treatment results with radiotherapy alone or with planned neck dissection.

PURPOSE: To present the results of radiotherapy with or without neck dissection for squamous cell carcinoma of the supraglottic larynx treated at the University of Florida and to compare these data with those obtained after conservation surgery. METHODS AND MATERIALS: Continuous-course radiotherapy alone or combined with a planned neck dissection was used to treat 274 patients with squamous cell carcinoma of the supraglottic larynx between 1964 and 1998. All patients had follow-up for a minimum of 2 years, and 250 (91%) had follow-up for 5 years or more. RESULTS: At 5 years, the actuarial probability of local control after radiotherapy according to T stage was as follows: T1, 100%; T2, 86%; T3, 62%; and T4, 62%. The probability of cause-specific survival at 5 years by AJCC stage was as follows: stage I, 100%; II, 93%; III, 81% IVA, 50%; and IVB, 13%. The risk of severe late complications was 4%. Of 57 patients undergoing planned postradiotherapy neck dissection, 7% experienced a severe complication. CONCLUSIONS: On the basis of our data and the literature, early or moderately advanced supraglottic carcinomas may be treated successfully with either supraglottic laryngectomy or radiotherapy. Supraglottic laryngectomy probably produces a higher initial local control rate but, based on anatomic and coexisting medical constraints, is suitable for a smaller subset of patients and has a higher risk of complications compared with radiotherapy.

Carcinoma, Squamous Cell↗
PubMed1994

Pathological findings in clinically false-negative and false-positive neck dissections for oral carcinoma.

A series of 86 patients presenting with oral cancer underwent neck dissection (114 sides of neck), after preoperative staging by palpation under general anaesthesia and CT imaging. Detailed histopathological assessment of the surgical neck dissection specimens showed the incidence of clinically false-negative and false-positive assessments was 27% and 40%, respectively. Extranodal spread of metastatic carcinoma was present in 16% of clinically negative necks. The pathological findings provided plausible explanations for the clinical misdiagnosis in all 19 of the false-positive necks and in 13 of the 18 false-negative necks, where micrometastases or metastasis to nodes measuring less than 1.7 cm accounted for five and seven misdiagnosed cases, respectively. We conclude that the most stringent clinical protocols, even when supplemented by CT scanning, cannot be expected to achieve 100% accuracy. Detailed histopathological assessment provides the most reliable, currently available method of diagnosing cervical metastatic disease.

Adult↗
PubMed2006

Selective neck dissection in patients with upper aerodigestive tract cancer with clinically positive nodal disease.

OBJECTIVES: We evaluated the efficacy of the application of selective neck dissection to cases of clinically node-positive disease. METHODS: We performed a retrospective review at the University of Pittsburgh Head and Neck Cancer Database. A database of 65 patients was followed for an average of 36 months (range, 2 to 128 months) after they underwent selective neck dissection for clinically node-positive regional disease. RESULTS: Regional failure occurred in 8 patients (12.3%). In-field failure was experienced in 4 patients (6.1%), and failures outside the field of dissection occurred in 4 patients (6.1%). The overall incidence of extracapsular spread was 33.8% (22 of 65). Only 2 of 8 regional recurrences were associated with extracapsular spread at the initial neck dissection; however, both recurrences were in the contralateral, undissected side of the neck. Four regional failures were salvaged with surgery, with eventual overall regional control in the neck of 93.9%. Only 1 of 4 ipsilateral recurrences (25%) was successfully salvaged. In contrast, 3 of 4 contralateral failures (75%) were successfully salvaged. In our study population, 21 of 65 cases (32%) that were initially staged as clinically node-positive had no evidence of nodal metastases on pathologic examination. CONCLUSIONS: The application of selective neck dissection and postoperative irradiation in patients with clinically Nl and limited N2 clinical disease appears to be oncologically efficacious. Clinical overstaging occurred frequently in this sample, and may put patients at risk for more morbid surgical procedures.

Follow-Up Studies↗