Selective Neck Dissection in Node-Positive Squamous Cell Carcinoma of the Head and Neck

• Published in: Otolaryngology-head and neck surgery Vol. 147; no. 4; pp. 707 - 715
• Main Authors: Givi, Babak, Linkov, Gary, Ganly, Ian, Patel, Snehal G., Wong, Richard J., Singh, Bhuvanesh, Boyle, Jay O., Shaha, Ashok R., Shah, Jatin P., Kraus, Dennis H.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-10-2012
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; Chemotherapy, Adjuvant; head and neck cancer; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - surgery; Humans; Lymph Node Excision; Lymphatic Metastasis - pathology; Male; Middle Aged; neck dissection; Neck Dissection - methods; Neoplasm Recurrence, Local; Prospective Studies; Radiotherapy, Adjuvant; Regression Analysis; surgical treatment; Survival Rate; Treatment Outcome; head and neck cancer; surgical treatment; neck dissection
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1177/0194599812444852

Objective
The optimal type of neck dissection in head and neck squamous cell carcinoma (SCC) with clinical cervical metastases has not been determined. The following study was performed to determine the rate of regional control with selective neck dissection (SND) in these patients.
Study Design
Case series with planned data collection.
Settings
Single institution, cancer center.
Methods and Subjects
Patients with cervical lymph node metastases from mucosal cancers of the head and neck who were treated with SND from 2000 to 2010 were selected. Demographics, tumor characteristics, extent of neck dissection, adjuvant treatments, locoregional control, and survival were recorded. Recurrence in the neck and disease-specific survival (DSS) were primary and secondary end points.
Results
One hundred eight patients underwent SND. Sixty-nine (64%) were male. Median age was 62 (20-89) years. The most common primary site was the oral cavity (71.3%). Ninety-five (88%) received adjuvant treatment. Median follow-up was 21 months. Six patients (5.5%) had isolated recurrence in the dissected neck. Patients with N2C disease had poorer neck recurrence-free survival. At the end of study, 64 (59.3%) patients had no evidence of disease, and 23 (21.3%) had died of disease. Two-year DSS was 76.9%. Number of positive nodes (P = .026) and positive surgical margins (P = .001), among others, were predictors of poorer DSS.
Conclusion
In a highly selected group of patients with cervical lymph node metastases from head and neck SCC, selective neck dissection is effective in controlling the disease in the neck when performed in the setting of a multimodality treatment, including adjuvant radiotherapy or radiochemotherapy.