Bilateral radical neck dissection: Results in 193 cases

Background and Objectives: Indications of simultaneous bilateral radical ne ck dissection remains controversial. The main objectives of this analysis w ere to study: a) the frequency of postoperative complications, b) the patte rns of metastatic lymph nodes in the surgical specimen, c) the predictive f actors of neck recurrences, d) the prognostic factors related to overall su rvival Methods: a retrospective review of results in 193 consecutive patients subm itted to a simultaneous bilateral radical neck dissection from 1960-1990. Results: Postoperative complications occurred in 60.8% of the cases. The mo st frequent ones were: fistula, wound infection, flap dehiscence and necros is. There were four postoperative deaths (2.7%). The lymph nodes most frequ ently involved were of the upper jugular and upper accessory groups. Only p atients with lip and paranasal sinus tumors never presented metastatic node s at Levels IV and V. Tumor recurrences were more common at the ipsilateral neck (13.5%) or at distant sites (12.4%). The predictive factors of neck r ecurrences were: age, N stage, ipsilateral metastasis at Level II, and cont ralateral metastasis at Levels II and IV. The overall 5-year survival rates for the two age groups, that is, younger than 40 and older than 40 years o f age, were respectively, of 8.5% and 35.6% (P = 0.0296). There were no sur vivals among the group of patients with neck lymph nodes staged as N3 or Nx . The overall 5-year survival rates were significantly influenced by contra lateral metastatic lymph nodes at any level. The results of multivariate an alysis using the Cox regression technique, showed that Level II ipsilateral metastatic lymph nodes, Levels II and TV contralateral metastatic lymph no des, and age were the independent predictors of the risk of death. Conclusions: This study demonstrates that simultaneous bilateral neck disse ction has a high morbidity and should be contraindicated as an elective pro cedure. Further studies with selective neck dissections are warranted. (C) 2000 Wiley-Liss, Inc.