SELECTIVE NECK DISSECTION AND THE MANAGEMENT OF THE NODE-POSITIVE NECK

OBJECTIVE: TO assess the oncologic effectiveness of the selective neck dissection (SND) in patients with both clinically and pathologically proven regional metastases. METHODS: A 4-year retrospective medical ch art review was conducted in an academic tertiary care referral center, Twenty-nine patients with a newly diagnosed upper aerodigestive tract squamous cell carcinoma, and both clinically and histologically prove n cervical metastases who underwent 36 SND, had their records reviewed , Minimum follow-up was 2 years. RESULTS: Regional metastasis were sta ged N1 in 13 patients, N2A in 1, N2B in 8, and N2C in 7. Seventeen sup raomohyoid and 19 lateral neck dissections were performed. Extracapsul ar spread of tumor was present in 11 patients. Postoperative radiation therapy was administered to 20 patients, Actuarial disease-specific s urvival at 4 years was 47% overall, 67% in N1 patients, and 41% in N2 patients, Only 1 failure in the treated neck occurred for a 4-year act uarial regional failure rate of 4%. The actuarial local failure and di stant metastasis rate were 36% each. CONCLUSIONS: In carefully selecte d patients with clinically and histologically apparent regional metast ases, the selective neck dissection can be an oncologically effective procedure, (C) 1996 by Excerpta Medica, Inc.