title: Efficacy of selective neck dissection for nodal metastasis with involvement of nonlymphatic structures.
abstract: BACKGROUND
  Our aim in carrying out this study was to determine the efficacy of selective neck dissection (SND) for cervical metastases with clinical involvement of adjacent nonlymphatic structures.
  
  
  METHODS
  In all, 39 patients were retrospectively analyzed with respect to 43 extended selective neck dissection (ESND) procedures.
  
  
  RESULTS
  Eighteen procedures were performed as part of the primary treatment and 25 for salvage following (chemo)radiation. Although most patients (84%) had nodal disease ≥N2, 91% had disease clinically confined to ≤2 neck levels. SND (levels II-IV) was most commonly performed and the internal jugular vein was the nonlymphatic structure most often sacrificed. Recurrence rate in the ipsilateral targeted neck was 0% and 13% in the primary surgery and postradiation groups, respectively.
  
  
  CONCLUSIONS
  SND that is extended to include adjacent nonlymphatic structures appears to be effective for advanced nodal metastasis confined to ≤2 nodal levels. We support the use of the term "extended selective neck dissection (ESND)" to describe this modification of neck dissection.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Simmons Cancer Institute, Southern Illinois University School of Medicine, Springfield, Illinois, USA.
authors.forename: Muthuswamy
authors.initials: M
authors.lastname: Dhiwakar
authors.forename: K Thomas
authors.initials: KT
authors.lastname: Robbins
authors.forename: Krishna
authors.initials: K
authors.lastname: Rao
authors.forename: Francisco
authors.initials: F
authors.lastname: Vieira
authors.forename: James
authors.initials: J
authors.lastname: Malone
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision / Q000706:statistics & numerical data; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods* / Q000401:mortality; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D018579:Patient Selection; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D016879:Salvage Therapy / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome