Selective neck dissections for squamous carcinoma of the upper aerodigestive tract: Patterns of regional failure

Background. Surgeons have been using selective neck dissections in the trea tment of squamous carcinoma of the upper aerodigestive tract for over 20 ye ars. To date, no data is available that can answer the question "What are t he patterns of failure in the neck following a selective neck dissection an d is a selective neck dissection a reliable procedure for metastatic diseas e?" Methods. To answer this question, the medical records of all patients with squamous carcinoma of the oral cavity, oropharynx, larynx, and hypopharynx treated at The University of Texas M. D. Anderson Cancer Center from Januar y 1, 1985-December 31, 1990, with a selective neck dissection were reviewed . Five hundred seventeen neck dissections were analyzed: suprahyoid (41), s upraomohyoid (284), and anterolateral (192). The end point of the study was regional failure and survival. Results. Regional recurrence in patients treated with a suprahyoid dissecti on was 43% with pathologically positive nodes. The regional recurrence in t he patients treated with a supraomohyoid neck dissection was 1.9% with path ologically negative nodes, 35.7% with path N1 without postoperative radiati on therapy, and 5.6% with postoperative radiation therapy. The neck staged pathologically N2B failed with and without postoperative radiation, 8.3% an d 14%, respectively. Thirteen percent of the anterior/lateral neck dissecti ons failed regionally. If multiple pathologically positive nodes (N2B) were present, the regional failure with postoperative radiation was 30% and 33. 3% without postoperative radiation. Conclusion. The results of this retrospective study suggest that a selectiv e neck dissection is a satisfactory staging procedure and is a definitive o peration if all the nodes are pathologically negative. However, if a node i s found to be invaded with cancer, the use of postoperative radiation is ad visable. (C) 1999 John Wiley & Sons, Inc.