EXTENDED NECK DISSECTION

BACKGROUND: This study defines the clinical settings in which extended radical neck dissection (ERND) was performed and determines its impac t on control of disease in the neck and on survival. METHODS: We revie wed the records of 106 patients undergoing ERND between 1984 and 1993. Most (76) had metastatic squamous cell carcinoma (SCC) that had exten ded to extranodal structures in the upper neck. RESULTS: Five-year dis ease-free survival was 39%, and disease was controlled in the neck in 72 patients (68%) with a median follow-up of 5.5 years. A trend toward better survival was seen in patients with SCC (47% at 5 years), compa red with those with other histologies (24% at 5 years; P < 0.12). Pati ents with levels I, II, or III involved had better survival (46% at 5 years) than those with level IV, V, or multiple levels involved (14% a t 5 years; P < 0.0088). Finally, when prior radiation therapy preclude d additional irradiation of the neck, survival was only 22% at 5 years , compared with 47% for those who received postoperative radiation (P < 0.017). CONCLUSIONS: Although advanced neck disease invading adjacen t structures remains an ominous sign, neck control and 5-year survival were achieved in nearly one half of these patients when multimodality therapy was possible, (C) 1997 by Excerpta Medica, Inc.