THE ROLE OF COMPREHENSIVE NECK DISSECTION WITH PRESERVATION OF THE SPINAL ACCESSORY NERVE IN THE CLINICALLY POSITIVE NECK

BACKGROUND: The most significant prognostic factor in patients with sq uamous cell carcinoma of the head and neck is the presence of cervical nodal metastases. Radical neck dissection is the standard by which. a ll cervical lymphadenectomy procedures are judged. In the presence of clinically positive nodal metastasis, the benefit of preserving the sp inal accessory nerve (SAN) has to be weighed against the possible risk of increased failure in the neck. We performed this retrospective stu dy to determine if preservation of the SAN in patients with clinically evident nodal metastases was associated with increased risk of failur e in the dissected neck. PATIENTS AND METHODS: Between January 1, 1984 and December 31, 1991, 378 comprehensive neck dissections were perfor med in 366 patients with clinically and pathologically positive nodal metastases from squamous carcinoma of the upper aerodigestive tract. W e compared survival, neck control rates, and other factors in patients who had a classic radical neck dissection (RND) to those who had modi fied radical neck dissection sparing only the SAN (MRND I). RESULTS: A ctuarial 5-year survival and neck failure rates for the RND group were 63% and 12%, compared to 71% and 8% for the MRND I group (P = NS). Su rvival and neck failure were not statistically different between the M RND I and RND groups when the analysis controlled for pathologic N sta ge, presence of extra capsular spread, and the presence of pathologica lly demonstrated metastatic nodes along the course of the SAN. Nor wer e there significantly different patterns of neck failure with RND vers us MRND. CONCLUSION: Modification RND to preserve an uninvolved SAN in the clinically positive neck does not adversely affect survival or ne ck control.