A SELECTIVE APPROACH TO NECK DISSECTION FOR MUCOSAL SQUAMOUS-CELL CARCINOMA

A personal series of 189 neck dissections performed over 6 years among 154 patients with mucosal squamous cell carcinoma is presented. The m ost common primary sites were the oral cavity (66), oropharynx (38) an d hypopharynx (17). There were 104 therapeutic and 85 elective neck di ssections. Over 40% of therapeutic dissections were modified or select ive procedures. Radical neck dissection was never used electively. Sev enty-eight patients (50%) had postoperative radiotherapy to the neck. Nodes were histologically positive in 110 dissections overall (58%); 9 2% of therapeutic dissections and 17% of elective dissections. Extraca psular spread was present in 65% of positive dissections. Ipsilateral neck recurrence developed in 10 of 60 patients who had therapeutic rad ical dissections (17%) and in 2 of 44 patients who had therapeutic, mo dified or selective dissections (5%). Recurrence after elective dissec tion occurred in only one patient (1.2%). It is concluded that modifie d and selective neck dissection are safe and oncologically effective w hen used among selected patients and combined with adjuvant radiothera py. Neck recurrence may still occur among patients with advanced and b iologically aggressive disease despite radical therapy.