Complications from planned, posttreatment neck dissections

Objective: To report the complication rate from planned, posttreatment neck dissections in patients who show control of primary squamous cell carcinom a by chemotherapy and radiotherapy or radiotherapy alone. Design: Retrospective review of case series. Setting: Georgetown University Medical Center, Washington, DC. Patients: Thirty-four patients with clinically positive neck disease treate d with organ preservation therapy for squamous cell carcinoma of the head a nd neck. Interventions: Planned neck dissection after treatment with chemotherapy an d radiotherapy or radiotherapy alone. Main Outcome Measure: Perioperative complications. Results: Forty-one neck dissections were performed on 34 patients. Complica tions were seen in 13 (38%) of 34 patients and 15 (37%) of 41 neck dissecti ons. Wound complications occurred in 9 (22%) of 41 dissections. Neck dissec tion complication rate did not correlate with previous use of chemotherapy or with the use of brachytherapy at the primary site at the time of the nec k dissection. Preoperative radiotherapy dose greater than 70 Gy was associa ted with complications in 58% vs 29% when preoperative dose was less than 7 0 Gy (P = .09). This trend was reflected primarily in wound complications ( 42% vs 14%; P = .10) and reached significance for skin flap necrosis (33% v s 0%; P = .005). Other factors that were associated with increased complica tions were preoperative albumin level less than 38 g/L and early neck drain removal. Conclusions: The complication rate associated with planned posttreatment ne ck dissection is similar to that previously reported for neck dissection. W ound complications are more common when higher preoperative radiotherapy do ses are used.