Node counts in neck dissection: Are they useful in outcomes research?

OBJECTIVES: We studied the unilateral nodal yields for procedures reported as standard or modified radical neck dissection (RND) to determine their ap plicability in outcomes research. METHODS: We analyzed the unilateral nodal yields for all procedures reporte d as RND for carcinoma of the oral cavity, pharynx, and larynx at our insti tution from 1985 to 1997 (n = 64, no prior treatment). These included both standard and modified techniques, encompassing levels I through V of the ne ck. Each side of a bilateral RND was treated as a separate case. This sampl e was compared with a similar population from the National Cancer institute 's Surveillance, Epidemiology, and End-Results (SEER) registry. Nodal yield was obtained for RND alone and for unspecified neck dissection with primar y excision for the same diseases and time period (n = 1499). RESULTS: The mean nodal yield from 64 RND was 30 vs 27 in the SEER data, Th e standard deviation was 14.7 compared with 17.2 in the SEER data. Values r anged from 7 to 66 nodes whereas the SEER range was from 1 to 97 nodes. Alt hough the SEER data contain nodal yields from regional or selective neck di ssection, we corroborate our findings of large variance in nodal yield from our RND sample. CONCLUSIONS: Large variance in nodal yields from RND may have undefined eff ects on quality of life, cure rate, and survival, Until correlation of noda l yields with outcomes is examined, we cannot know how to relate RND to out comes.