Pain, quality of life, and spinal accessory nerve status after neck dissection

Objective: To assess quality of Life (QOL) in patients with head and neck c ancer who underwent neck dissection and to compare QOL scores for patients in whom the spinal accessory nerve (CN XI was resected or preserved. Settin g and Design and Outcomes Measures: Three hundred ninety-seven patients who had undergone treatment for head and neck cancer completed the University of Michigan Head and Neck Quality of Life (HNQOL) instrument, the Medical O utcomes Study SF-12 General Health Survey, and questions on "pain despite p ain medications" and headaches. Results: Of the 397 patients, 222 had no ne ck dissection, 46 had neck dissections resecting CN XI, and 129 had dissect ion sparing CN XI. Of the latter group, 68 patients had dissections sparing level V and 61 dissections included level V. Age, ses, primary site distri bution, and T stage were not different between the groups. Patients who had neck dissections sparing CN XI had better scores on the HNQOL pain domain (P = .002), had less shoulder or neck pain (P = .003), and took pain medica tions less frequently (P = .0001) compared with patients who had neck disse ctions sacrificing CN XI. When CN ICI was preserved, patients who had no le vel V dissection had better pain domain scores (P = .03) and eating domain scores (P = .007) on the HNQOL, had less shoulder or neck pain (P = .006), and had less physical problems (P = .03) than patients who had level V diss ected. On multivariate analysis, pain-related QOL scores after neck dissect ion were significantly better (P < .01) if patients had dissections with pr eservation of CN XI and if level V was not dissected. Conclusion: Neck diss ections sparing CN XI are associated with better pain scores on the HNQOL, less shoulder and neck pain, and less need for medications. When CN XI is s pared, not dissecting lever V of the neck is associated with better HNQOL p ain scores, less shoulder or neck pain, and fewer physical problems.