We read with great interest the recent article in the ARCHIVES by Clayman and Frank1on the place of selective neck dissection in the elective treatment of the clinically negative neck. The authors have depicted the problem objectively. We are, however, inclined to dispute their conclusion on the value of selective neck dissection from a scientific point of view and would concur with Johnson2 that there is a lack of adequate data. In medicine there is a current trend toward more evidence-based decision making, which is mainly directed by epidemiologists, health care providers, and the government. This movement could be regarded as an acceptable limitation of clinical freedom with the aim to provide better care for patients through a more scientific basis. As in many other specialties, a minority of current decisions on head and neck oncology are based on evidence acquired by randomized clinical trials. The remainder of decisions are largely based on convincing but nonexperimental evidence, and this "gray zone" is by nature often incomplete and contradictory. The prototype example of everyday decision making in head and neck surgery in this controversial gray zone is the management of the clinically negative (N0) neck. If the surgeon decides to treat the neck, the key question is which type of neck dissection needs to be performed—a modified radical neck dissection (MRND) or selective neck dissection (SND).
Leemans CR, Snow GB. Is Selective Neck Dissection Really as Efficacious as Modified Radical Neck Dissection for Elective Treatment of the Clinically Negative Neck in Patients With Squamous Cell Carcinoma of the Upper Respiratory and Digestive Tracts? Arch Otolaryngol Head Neck Surg. 1998;124(9):1042–1044. doi:10.1001/archotol.124.9.1042
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