EXPANDED APPLICATION OF SELECTIVE NECK DISSECTION WITH REGARD TO NODAL STATUS

Background. The efficacy of extending the application of selective nec k dissection to include more-extensive neck disease in patients with s quamous carcinoma of the upper aerodigestive tract remains controversi al. Methods. A review of all patients undergoing selective neck dissec tion at a single institution during a 5-year period was undertaken, Th e analysis was conducted on 82 patients who received 94 selective neck dissections as part of initial therapy far management of squamous car cinoma of the upper aerodigestive tract, including: oral cavity, oroph arynx: larynx, and hypopharynx. Results. Forty-six of the 94 dissected necks were supraomohyoid dissections, and 48 were lateral neck dissec tions. Sixty-live percent of patients were followed a minimum of 2 yea rs and formed the cohort for final analysis. There were eight regional recurrences, three of which occurred in the contralateral, undissecte d neck. The regional recurrence rate for all patients undergoing selec tive neck dissection, with or without radiotherapy, according to patho logic N status was as follows: NO (1133), 3%; N1 (1/8), 12.5%; and mul tiple positive nodes (3/26), 11.5%. A comparison of recurrence rates w ith respect to extent of neck disease (N0-N1 versus multiple positive nodes) for both types of neck dissection did not demonstrate significa nt differences; supraomohyoid neck dissection, p < .5; lateral neck di ssection, p < .25. Conclusions. There exists an expanded role for sele ctive neck dissection in selected patients with primary squamous cell carcinoma of the upper aerodigestive tract and multiple N+ cervical di sease. The selection of patients who are candidates for selective lymp hadenectomy should be based on pathoanaiomic considerations with refer ence to the primary site of tumor and 00demonstrated level(s) of metas tatic involvement. (C) 1997 John Wiley & Sons, Inc.