title: Neck dissection after chemoradiotherapy: timing and complications.
abstract: OBJECTIVE
  To determine the incidence of postchemoradiotherapy (post-CRT) neck dissection (ND) complications; to ascertain whether timing (< 12 vs ≥ 12 weeks) from CRT to ND or other factors are associated with increased complications; and to determine whether ND timing influences disease control or survival.
  
  
  METHODS
  Ten-year retrospective analysis.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  One hundred five patients with head and neck cancer undergoing ND after CRT.
  
  
  METHODS
  Complications and survival variables compared between groups undergoing ND less than 12 weeks (less-than-12-weeks ND group) and 12 weeks or more (12-weeks-or-more ND group) after CRT.
  
  
  RESULTS
  Sixty-seven NDs were performed less than 12 weeks and 38 were performed 12 weeks or more after CRT. Patient characteristics, treatment, and ND pathology results were comparable between the 2 ND groups. The incidence of complications between the less-than-12-weeks and the 12-weeks-or-more ND groups included major wound complications in 8 of 67 (11.9%) vs 1 of 38 (2.6%; P = .15), minor wound complications in 11 of 67 (16.4%) vs 4 of 38 (10.5%; P = .56), airway complications in 7 of 67 (10.4%) vs 2 of 38 (5.3%; P = .48), and systemic complications in 9 of 67 (13.4%) vs 2 of 38 (5.3%; P = .32). The number of patients with at least 1 complication was significantly smaller in the 12-weeks-or-more ND group (P = .04). Multivariate analysis showed that radical ND was significantly associated with an increased number of complications, and higher radiation doses approached significance (P = .05). Induction chemotherapy was associated with fewer wound complications (P = .01). There were no significant differences in overall survival (P = .82), progression-free survival (P = .77), or regional relapse (P = .54) between groups. Positive ND findings were associated with diminished progression-free and overall survival.
  
  
  CONCLUSIONS
  These findings indicate that ND can be safely performed 12 weeks or more after CRT without adversely affecting surgical complications or survival variables.
authors.affiliation: Division of Otolaryngology, Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA. lgoguen@partners.org
authors.forename: Laura A
authors.initials: LA
authors.lastname: Goguen
authors.forename: Claudia I
authors.initials: CI
authors.lastname: Chapuy
authors.forename: Yi
authors.initials: Y
authors.lastname: Li
authors.forename: Sihai D
authors.initials: SD
authors.lastname: Zhao
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Annino
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods*; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome