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Original Article
October 2002

Results of Selective Neck Dissection in Management of the Node-Positive Neck

Author Affiliations

From the Department of Otolaryngology/Head and Neck Surgery, Oregon Health Sciences University, Portland (Drs Andersen, Warren, Burningham, Wax, and Cohen); University of Connecticut Health Center, Farmington (Dr Spiro); and the Memorial Sloan-Kettering Cancer Center, New York, NY (Drs Wong and Shah).

Arch Otolaryngol Head Neck Surg. 2002;128(10):1180-1184. doi:10.1001/archotol.128.10.1180

Background  Although increasingly accepted in treatment of the N0 neck, use of selective neck dissection in patients with node-positive squamous cell carcinoma of the head and neck remains controversial.

Objective  To determine the oncologic efficacy of selective node dissection in patients with node-positive squamous carcinoma of the head and neck.

Setting  Three tertiary care academic/Veterans Affairs medical centers.

Methods  Ten-year retrospective medical chart review of 106 previously untreated clinically and pathologically node-positive patients undergoing 129 selective neck dissections and followed for a minimum of 2 years or until patient death.

Results  Regional metastasis was clinically staged as N1 in 58 patients (54.7%), N2a in 5 (4.7%), N2b in 28 (26.4%), N2c in 14 (13.2%), and N3 in 1 (0.9%). Extracapsular extension of tumor was present in 36 patients (34.0%), and postoperative radiation therapy was administered to 76 patients (71.7%). Overall, 9 patients experienced disease recurrence in the neck. Six of these recurrences were in the side of the neck that had undergone selective neck dissection, for a regional control rate of 94.3%.

Conclusions  These results support the use of selective neck dissection in carefully selected patients with clinically node-positive squamous cell carcinoma of the head and neck region. Regional control rates comparable to those achieved with comprehensive operations can be achieved in appropriately selected patients.