title: The impact of surgical technique on neck dissection nodal yield: making a difference.
abstract: The nodal yield of neck dissections is an independent prognostic factor in several types of head and neck cancer. The authors aimed to determine whether the applied dissection technique has a significant impact on nodal yield. This is a single-institution, prospective study with internal control group (level of evidence: 2A). Data of 150 patients undergoing 223 neck dissections between February 2011 and March 2013 have been collected in a comprehensive cancer centre. Eighty-two patients underwent neck dissection with unwrapping the cervical fascia from lateral to medial, while 68 patients were operated without specifically unwrapping the fascia, in a caudal to cranial fashion. The standardised, horizontal neck dissection technique along the fascial planes resulted in a significantly higher nodal count in Levels I, II, III and IV, as well as in terms of overall nodal yield (mean: n = 22.53) than that of the vertical dissection applied in the control group (mean: n = 15.00). This is the first publication showing a direct correlation between neck dissection nodal yield and surgical technique. Therefore, it is paramount to optimise the applied surgical concept to maximise the oncological benefit.
authors.affiliation: Head and Neck Cancer Centre of the Hubertus Wald University Cancer Centre Hamburg, Hamburg, Germany.|Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Balazs B
authors.initials: BB
authors.lastname: Lörincz
authors.affiliation: Head and Neck Cancer Centre of the Hubertus Wald University Cancer Centre Hamburg, Hamburg, Germany.|Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Langwieder
authors.affiliation: Head and Neck Cancer Centre of the Hubertus Wald University Cancer Centre Hamburg, Hamburg, Germany.|Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Möckelmann
authors.affiliation: Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Sehner
authors.affiliation: Head and Neck Cancer Centre of the Hubertus Wald University Cancer Centre Hamburg, Hamburg, Germany. r.knecht@uke.de.|Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. r.knecht@uke.de.
authors.forename: Rainald
authors.initials: R
authors.lastname: Knecht
mesh_terms: D000328:Adult; D000368:Aged; D057186:Comparative Effectiveness Research; D005260:Female; D005858:Germany; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods / Q000592:standards; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009333:Neck; D037981:Neck Dissection / Q000379:methods / Q000592:standards; D011379:Prognosis; D011446:Prospective Studies; D047368:Tumor Burden
keywords: Cervical fascia; Fascia unwrapping; Head and neck cancer; Neck dissection; Nodal yield; Surgical staging; Surgical technique