title: Selective neck dissection in patients with upper aerodigestive tract cancer with clinically positive nodal disease.
abstract: OBJECTIVE
  We evaluated the efficacy of the application of selective neck dissection to cases of clinically node-positive disease.
  
  
  METHODS
  We performed a retrospective review at the University of Pittsburgh Head and Neck Cancer Database. A database of 65 patients was followed for an average of 36 months (range, 2 to 128 months) after they underwent selective neck dissection for clinically node-positive regional disease.
  
  
  RESULTS
  Regional failure occurred in 8 patients (12.3%). In-field failure was experienced in 4 patients (6.1%), and failures outside the field of dissection occurred in 4 patients (6.1%). The overall incidence of extracapsular spread was 33.8% (22 of 65). Only 2 of 8 regional recurrences were associated with extracapsular spread at the initial neck dissection; however, both recurrences were in the contralateral, undissected side of the neck. Four regional failures were salvaged with surgery, with eventual overall regional control in the neck of 93.9%. Only 1 of 4 ipsilateral recurrences (25%) was successfully salvaged. In contrast, 3 of 4 contralateral failures (75%) were successfully salvaged. In our study population, 21 of 65 cases (32%) that were initially staged as clinically node-positive had no evidence of nodal metastases on pathologic examination.
  
  
  CONCLUSIONS
  The application of selective neck dissection and postoperative irradiation in patients with clinically Nl and limited N2 clinical disease appears to be oncologically efficacious. Clinical overstaging occurred frequently in this sample, and may put patients at risk for more morbid surgical procedures.
authors.affiliation: Department of Surgery, Loma Linda University School of Medicine, Loma Linda, California (Simental), USA.
authors.forename: Alfred A
authors.initials: AA
authors.lastname: Simental
authors.forename: Umamaheswar
authors.initials: U
authors.lastname: Duvvuri
authors.forename: Jonas T
authors.initials: JT
authors.lastname: Johnson
authors.forename: Eugene N
authors.initials: EN
authors.lastname: Myers
mesh_terms: D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008207:Lymphatic Metastasis; D037981:Neck Dissection / Q000379:methods*; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome