Selective neck dissection for node-positive necks in patients with head and neck squamous cell carcinoma: a word of caution

OBJECTIVE: To evaluate the regional recurrence (RR) rate in a consecutive series of patients with node-positive head and neck squamous cell carcinoma (N(+) HNSCC) who underwent selective neck dissection (SND) as part of their treatment in a single institution. DESIGN: Retrospective case series with 2 years of follow-up. SETTING: Tertiary care university hospital. PATIENTS: One hundred ninety-one patients with N(+) HNSCC underwent 256 neck dissections (NDs) between 1999 and 2002. Of these, 17 had unilateral SNDs and 11 had bilateral NDs (6 patients, bilateral SND; 5 patients, radical ND and SND). There were 22 men and 6 women, ranging in age from 37 to 79 years (median age, 53 years), with 17 laryngeal, 5 hypopharyngeal, 4 oral cavity, 1 oropharyngeal, and 1 nasopharyngeal primary tumors, which were classified as follows: T1 (n=2 7.1%]), T2 (n=2 7.1%]), T3 (n=7 25.0%]), and T4 (n=17 60.8%]). The neck stages were N1 (n=8 28.6%]), N2a (n=2 7.1%]), N2b (n=7 25.0%]), and N2c (n=11 39.3%]). Most patients had tumors that were stage III (14.3%) or stage IV (85.7%) and had undergone postoperative radiotherapy. The minimum follow-up period was 2 years (median follow-up period, 36 months). Two patients (7.1%) died of postoperative complications, and 2 became unavailable for follow-up before 12 months. MAIN OUTCOME MEASURE: The RR rate. RESULTS: There were 4 RRs (11.8%) among 34 patients who underwent SND, and 2 RRs (40%) among 5 patients who underwent radical ND. None of the patients with T1 or T2 tumors had recurrences; 1 (14.3%) of 7 patients with T3 tumors and 3 (17.6%) of 17 patients with T4 disease had RRs. One (12.5%) of 8 patients with N1 stage cancer, none of 2 patients with N2a stage cancer, 2 (28.6%) of 7 patients with N2b stage cancer, and 1 (9.1%) of 11 patients with N2c stage cancer had RRs. CONCLUSIONS: The RR rate was acceptable in patients with T1/T2 tumors and N1 nodal stage disease. However, it was higher in those with advanced T tumors and/or N2b stage cancer.