Efficacy of selective neck dissection for nodal metastasis with involvement of nonlymphatic structures

Head Neck. 2011 Aug;33(8):1099-105. doi: 10.1002/hed.21587. Epub 2010 Nov 10.

Abstract

Background: Our aim in carrying out this study was to determine the efficacy of selective neck dissection (SND) for cervical metastases with clinical involvement of adjacent nonlymphatic structures.

Methods: In all, 39 patients were retrospectively analyzed with respect to 43 extended selective neck dissection (ESND) procedures.

Results: Eighteen procedures were performed as part of the primary treatment and 25 for salvage following (chemo)radiation. Although most patients (84%) had nodal disease ≥N2, 91% had disease clinically confined to ≤2 neck levels. SND (levels II-IV) was most commonly performed and the internal jugular vein was the nonlymphatic structure most often sacrificed. Recurrence rate in the ipsilateral targeted neck was 0% and 13% in the primary surgery and postradiation groups, respectively.

Conclusions: SND that is extended to include adjacent nonlymphatic structures appears to be effective for advanced nodal metastasis confined to ≤2 nodal levels. We support the use of the term "extended selective neck dissection (ESND)" to describe this modification of neck dissection.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell / mortality
  • Carcinoma, Squamous Cell / secondary*
  • Carcinoma, Squamous Cell / surgery*
  • Chemotherapy, Adjuvant
  • Cohort Studies
  • Databases, Factual
  • Disease-Free Survival
  • Female
  • Head and Neck Neoplasms / mortality
  • Head and Neck Neoplasms / pathology
  • Head and Neck Neoplasms / surgery*
  • Humans
  • Lymph Node Excision / statistics & numerical data
  • Lymph Nodes / pathology*
  • Lymph Nodes / surgery
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Neck Dissection / methods*
  • Neck Dissection / mortality
  • Neoplasm Invasiveness
  • Neoplasm Recurrence, Local / mortality
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Recurrence, Local / therapy*
  • Neoplasm Staging
  • Patient Selection
  • Prognosis
  • Radiotherapy, Adjuvant
  • Retrospective Studies
  • Risk Assessment
  • Salvage Therapy / methods*
  • Survival Analysis
  • Treatment Outcome