Selective neck dissection in the management of the clinically node-negative neck.
OBJECTIVE
To evaluate the efficacy of the selective neck dissection (SND) in the management of the clinically node-negative neck.


METHODS
Case histories were evaluated retrospectively.


METHODS
The results of 300 neck dissections performed on 210 patients were studied.


RESULTS
The primary sites were oral cavity (91), oropharynx (30), hypopharynx (16), and larynx (73). Seventy-one necks (23%) were node positive on pathological examination. The number of positive nodes varied from 1 to 9 per side. Of necks with positive nodes, 17 (24%) had extracapsular spread. The median follow-up was 41 months. Recurrent disease developed in the dissected neck of 11 patients (4%). Two recurrences developed outside the dissected field. The incidence of regional recurrences was similar in patients in whom nodes were negative on histological examination (3%) when compared with patients with positive nodes without extracapsular spread (4%). In contrast, regional recurrence developed in 18% of necks with extracapsular spread. This observation was statistically significant. Patients having more than two metastatic lymph nodes had a higher incidence of recurrent disease than the patients with carcinoma limited to one or two nodes. Recurrence rate in the pathologically node positive (pN+) necks was comparable to recurrence in those pathologically node negative (pNO) necks in the patients who did not have irradiation.


CONCLUSIONS
SND is effective for controlling neck disease and serves to detect patients who require adjuvant therapy.
Hosal
A S
AS
Department of Otolaryngology--Head and Neck Surgery, Hacettepe University Medical Faculty, Ankara, Turkey.
Carrau
R L
RL
Johnson
J T
JT
Myers
E N
EN
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies