title: Current philosophy in the surgical management of neck metastases for head and neck squamous cell carcinoma.
abstract: Neck dissection is an important treatment for metastases from upper aerodigestive carcinoma; an event that markedly reduces survival. Since its inception, the philosophy of the procedure has undergone significant change from one of radicalism to the current conservative approach. Furthermore, nonsurgical modalities have been introduced, and, in many situations, have supplanted neck surgery. The refinements of imaging the neck based on the concept of neck level involvement has encouraged new philosophies to evolve that seem to benefit patient outcomes particularly as this relates to diminished morbidity. The purpose of this review was to highlight the new paradigms for surgical removal of neck metastases using an evidence-based approach.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Uludag University School of Medicine, Bursa, Turkey.
authors.forename: H Hakan
authors.initials: HH
authors.lastname: Coskun
authors.affiliation: Department of Otorhinolaryngology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
authors.forename: Jesus E
authors.initials: JE
authors.lastname: Medina
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois.
authors.forename: K Thomas
authors.initials: KT
authors.lastname: Robbins
authors.affiliation: Departments of Surgery and Otolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.
authors.forename: Carl E
authors.initials: CE
authors.lastname: Silver
authors.affiliation: Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia.
authors.forename: Primož
authors.initials: P
authors.lastname: Strojan
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Marburg, Marburg, Germany.
authors.forename: Afshin
authors.initials: A
authors.lastname: Teymoortash
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Guthrie Health System, Sayre, Pennsylvania.
authors.forename: Phillip K
authors.initials: PK
authors.lastname: Pellitteri
authors.affiliation: Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.|Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Rodrigo
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Kantonsspital, St. Gallen, Switzerland.
authors.forename: Sandro J
authors.initials: SJ
authors.lastname: Stoeckli
authors.affiliation: Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Ashok R
authors.initials: AR
authors.lastname: Shaha
authors.affiliation: Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.|Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Suárez
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France.|Laboratoire de Phonétique et de Phonologie, Sorbonne Nouvelle, Paris, France.
authors.forename: Dana M
authors.initials: DM
authors.lastname: Hartl
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Remco
authors.initials: R
authors.lastname: de Bree
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Takes
authors.affiliation: Department of Head and Neck Surgery, Head and Neck Oncology Program, St Luc University Hospital and Cancer Center, Brussels, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: Hamoir
authors.affiliation: Department of Surgery, Banner MD Anderson Cancer Center, Gilbert, Arizona.
authors.forename: Karen T
authors.initials: KT
authors.lastname: Pitman
authors.affiliation: ENT Clinic, University of Udine, Udine, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Rinaldo
authors.affiliation: ENT Clinic, University of Udine, Udine, Italy.
authors.forename: Alfio
authors.initials: A
authors.lastname: Ferlito
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D018572:Disease-Free Survival; D019317:Evidence-Based Medicine; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D037981:Neck Dissection / Q000379:methods* / Q000401:mortality; D011379:Prognosis; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: clinically negative neck; clinically positive neck; head and neck squamous cell carcinoma; neck dissection; neck metastasis