title: Effectiveness of selective neck dissection in the treatment of the clinically positive neck.
abstract: BACKGROUND
  The aim of this work was to determine whether or not patients treated with therapeutic selective neck dissection for head and neck squamous cell carcinoma were oncologically disadvantaged compared with those having comprehensive procedures.
  
  
  METHODS
  The study involves a retrospective review of 232 therapeutic neck dissections with a minimum of 2 years follow-up.
  
  
  RESULTS
  Patients having selective neck dissection had fewer adverse prognostic factors compared with patients having comprehensive dissection (pN2/3, p = .001; and extracapsular spread, p = .001). There were trends toward improved control in the dissected neck (96% vs 86%, p = .06), and disease-specific survival (59% vs 43%, p = .06) following selective neck dissection. Disease-specific survival for all patients was adversely affected by pN classification (p <.001) and extracapsular spread (p <.001).
  
  
  CONCLUSIONS
  Patients undergoing aggressive neck surgery had more extensive disease. Selective neck dissection can be used to effectively treat clinically positive nodal disease in selected patients.
authors.affiliation: Sydney Head and Neck Cancer Institute, Sydney Cancer Centre, Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia. dr_rajan_patel@hotmail.com
authors.forename: Rajan S
authors.initials: RS
authors.lastname: Patel
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Clark
authors.forename: Kan
authors.initials: K
authors.lastname: Gao
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: O'Brien
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015331:Cohort Studies; D016001:Confidence Intervals; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods* / Q000401:mortality; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome