title: Is elective neck dissection indicated during salvage surgery for head and neck squamous cell carcinoma?
abstract: Among patients with head and neck squamous cell carcinoma with a negative neck who are initially treated with (chemo)radiotherapy, a number of cases will recur locally without obvious neck recurrence. There is little information available as to the most efficacious management of the neck in these cases. We have reviewed the literature to see what conclusions can be drawn from previous reports. We conducted a bibliography search on MEDLINE and EMBASE databases. Studies published in the English language and those on squamous cell carcinoma of the oral cavity, nasopharynx, oropharynx, larynx and hypopharynx were included. Data related to neck management were extracted from the articles. Twelve studies satisfied the inclusion criteria. Five studies reported only one treatment plan (either neck dissection or observation), while the others compared neck dissection to observation. The rate of occult metastases ranged from 3.4 to 12 %. The studies included a variable distribution of primary sites and stages of the recurrent primary tumors. The risk of occult neck node metastasis in a clinically rN0 patient correlated with tumor site and T stage. Observation of the neck can be suggested for patients with T1-2 glottic tumors, who recurred with less advanced tumors (rT1-2). For patients with more advanced laryngeal recurrences or recurrence at other high-risk sites, neck dissection could be considered for the rN0 patient, particularly if the neck was not included in the previous radiation fields.
authors: Department of Surgery, Universidad de Antioquia, Hospital Pablo Tobón Uribe, Medellín, Colombia.
authors: Alvaro
authors: A
authors: Sanabria
authors: Carl E
authors: CE
authors: Silver
authors: Kerry D
authors: KD
authors: Olsen
authors: Jesus E
authors: JE
authors: Medina
authors: Marc
authors: M
authors: Hamoir
authors: Vinidh
authors: V
authors: Paleri
authors: Vanni
authors: V
authors: Mondin
authors: Alessandra
authors: A
authors: Rinaldo
authors: Juan P
authors: JP
authors: Rodrigo
authors: Carlos
authors: C
authors: Suárez
authors: Carsten C
authors: CC
authors: Boedeker
authors: Michael L
authors: ML
authors: Hinni
authors: Luiz P
authors: LP
authors: Kowalski
authors: Afshin
authors: A
authors: Teymoortash
authors: Jochen A
authors: JA
authors: Werner
authors: Robert P
authors: RP
authors: Takes
authors: Alfio
authors: A
authors: Ferlito
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000556:secondary; D017558:Elective Surgical Procedures; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery; D006801:Humans; D008207:Lymphatic Metastasis; D009333:Neck / Q000473:pathology / Q000601:surgery; D037981:Neck Dissection / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*