Therapeutic selective neck dissection outcomes.
OBJECTIVE
To evaluate the effectiveness of selective neck dissection in patients with nodal metastases from head and neck squamous cell carcinoma.


METHODS
Historical cohort study.


METHODS
Academic medical center.


METHODS
A chart review was performed on 156 subjects with clinically positive regional nodal metastases managed initially with surgery, including neck dissection. Sixty-nine subjects underwent selective neck dissection (less than 5 levels), and the majority received postoperative radiotherapy (80%). Primary outcomes included Kaplan-Meier three-year ipsilateral regional control and five-year overall survival. Cox proportional univariate and multivariate analyses were performed to determine those factors associated with outcome.


RESULTS
There were two ipsilateral regional recurrences among those undergoing selective neck dissection, yielding a regional control rate of 95.9 percent. Among those undergoing comprehensive neck dissection, nine ipsilateral regional recurrences occurred, yielding a control rate of 86.0 percent (P = 0.053). No selective neck dissection recurrences occurred in a preserved level. Selective neck dissection, as compared to comprehensive neck dissection, was not adversely associated with regional recurrence, survival, or distant metastasis, even after adjusting for possible confounders (hazard ratio 0.21, P = 0.055).


CONCLUSIONS
These results demonstrate high rates of regional disease control (96%) following selective neck dissection and radiotherapy in patients with positive neck node metastases. In this population, performing selective neck dissection with adjuvant radiotherapy for the majority of patients is supported as an effective treatment approach.
Shepard
Peter M
PM
Department of Surgery, Otolaryngology Division, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA. peteshepard@hotmail.com
Olson
Jordan
J
Harari
Paul M
PM
Leverson
Glen
G
Hartig
Gregory K
GK
D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods; D009364:Neoplasm Recurrence, Local; D016896:Treatment Outcome