The role of supraomohyoid neck dissection in patients with positive nodes

Background: Supraomohyoid neck dissection (SOHND) is:currently used as a st aging procedure for patients with clinically negative nodes in the neck who are at increased risk ( >20%) for metastatic disease. Objective: To assess the potential role of SOHND in patients with clinicall y positive nodes at levels I, II, or III. We evaluated, in particular, whet her selective neck dissection in patients with clinically positive nodes re sults in decreased regional control and/or diminished survival. Patients; and Methods: We retrospectively reviewed the charts of all patien ts who underwent SOHND from January 1, 1971, to December 31, 1997. The oral cavity and oropharynx represented the primary sites in the majority of the patients. Two-year follow-up information was available an all patients. Results: During the study period, 69 patients underwent 84 SOHNDs. Of the 6 9 patients, there were 30 patients with clinically negative nodes and 39 pa tients with clinically positive nodes in the neck, The overall regional con trol rates were 88% vs 71% for pathologically negative vs positive nodes, r espectively, with or without adjuvant radiation therapy. Adjuvant radiation therapy significantly improved regional control in patients with pathologi cally positive nodes but not in patients with N0 disease (P =.005). Similar results were noted in patients with both clinically and pathologically pos itive nodes. Conclusions: Supraomohyoid neck dissection in patients with pathologically positive nodes in the neck is inadequate therapy for regional control witho ut postoperative radiation therapy. However, in patients with pathologicall y positive nodes in the neck, SOHND with postoperative radiation therapy ca n achieve regional control comparable to that of comprehensive neck dissect ion and postoperative radiation therapy.