CLASSIFICATION OF NECKS DISSECTION - VARIATIONS ON A NEW THEME

BACKGROUND: Commencing in 1984, we initiated a head and neck service s urgical database that included a classification system for neck dissec tion. The aim was to reduce tile confusion in terminology resulting fr om growing interest in modifications of conventional radical neck diss ection. METHODS: We considered a neck dissection as radical when four or five lymph node levels were excised; this included patients who had an otherwise classical neck dissection for supraglottic larynx or hyp opharyngeal cancer sparing level 1. Lymph-node levels removed, nonlymp hatic structures preserved, and excised nonlymphatic structures not or dinarily included in a classical radical neck dissection were all spec ified by the operating surgeon. We defined as a selective neck dissect ion any lymphadenectomy that encompassed no more than three nodal leve ls, usually supraomohyoid (levels 1, 2, 3), or jugular (levels 2, 3, 4 ). We defined as a limited neck dissection any lymphadenectomy that in volved removal of no more than two nodal levels. RESULTS: At the 10-ye ar mark, this database of 10,650 patients now includes 2,635 lymphaden ectomies in 2,426 patients, the precise extent of which is accurately described in each patient. CONCLUSIONS: The current classification of neck dissection does not cover all possibilities. If we define as radi cal those lymphadenectomies that resect four or five nodal levels and specify structures preserved or additional nonlymphatic structures sac rificed, we allow for the possibility that some procedures may be both modified and extended. Selective would describe the standard, three-l evel dissections (eg, supraomohyoid or jugalar node dissections), and the term limited would be introduced to indicate a neck dissection tha t involves removal of no more than two nodal levels. Such a three-tier ed classification would more accurately reflect the time and effort in volved and provide a more equitable basis for reimbursement.