THE EXTENT OF NECK DISEASE AFTER REGIONAL FAILURE DURING OBSERVATION OF THE NO NECK

BACKGROUND: The optimum management of the No neck remains controversia l, When the neck is observed it is hoped that close follow-up will det ect regional failure at an early stage, To test this hypothesis we exa mined patients undergoing therapeutic neck dissection for newly develo ped neck metastases during observation after treatment of the primary tumor. METHODS: A retrospective chart review of 47 patients undergoing neck dissection for regional failure after surgical treatment of the primary tumor and observation of the neck from 1987 to 1992 was perfor med. The median time to failure in the neck was 13 months. RESULTS: Th e clinical neck stage at the time of neck dissection was N-1 in 37, N- 2A in 6, N-2B in 1, and N-3 in 3, However, pathologic staging revealed stages of N-1 in 19, N-2A in 5, N-2B in 20, and N-3 in 3. Extracapsul ar spread (ECS) was present in 23 patients (49%). Overall 36 patients (77%) had adverse pathologic findings (N greater than 1 or ECS), CONCL USIONS: These data indicate that when observation is used for the neck at risk for metastasis, patients tend to fail with high stage disease in the neck. This supports the philosophy of elective treatment of th e neck but cannot show whether elective treatment will improve surviva l. (C) 1996 by Excerpta Medica, Inc.