Therapeutic selective neck dissection: a 25-year review

OBJECTIVES/HYPOTHESIS: The aim of the study was to show the efficacy of selective neck dissection in combination with postoperative radiation therapy in controlling squamous cell carcinoma metastatic to the cervical lymph nodes. The study compared the incidence of recurrences and overall disease-free survival between comparable cohorts undergoing a selective neck dissection and classic radical or modified neck dissection. STUDY DESIGN: Retrospective, 25-year review was made of data from a tertiary care academic facility comprising both private patients and veterans. METHODS: Inclusion criteria studied patients with untreated head and neck cancer who had squamous carcinoma metastatic to cervical lymph nodes on histological examination and were treated with a selective (n = 61), modified (n = 54), or radical neck dissection (n = 61). The three groups were compared with respect to regional control and overall cancer-free survival. All patients remained cancer free at the primary site, received postoperative radiation therapy, and had a minimum follow-up of 2 years. The median follow-up was 4.3 years. RESULTS: Control of recurrent carcinoma in the neck, as well as the incidence of overall cancer-free survival, was comparable in the three cohorts with no significant statistical difference. Eight of 176 sides of the necks (4.5%) showed evidence of recurrence (2 of 61 [3.3%] in the selective neck dissection group and 6 of 115 [5.2%] in the radical and modified neck dissection group. Disease-free 2-year survival was 80% in the selective neck dissection group and 64% in the radical and modified neck dissection group. CONCLUSION: Selective neck dissection, when used in combination with postoperative radiation therapy, is an efficacious way to manage metastatic squamous cell carcinoma to the neck.