title: Shoulder Dysfunction after Selective Neck Dissection in Recurrent Nasopharyngeal Carcinoma.
abstract: OBJECTIVE
  To investigate the incidence of occult nodal metastasis and severity of shoulder dysfunction after selective neck dissection (SND) for recurrent nasopharyngeal carcinoma (NPC) with N0 status.
  
  
  METHODS
  Prospective, single-group, pre/post test design.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  Between 1998 and 2012, 46 patients who had recurrent NPC and N0 status were recruited. They subsequently received salvage nasopharyngectomy and SND, removing ipsilateral level I to III and V lymphatics. The incidence of occult nodal metastasis was noted. All patients underwent standardized physiotherapy after surgery. Postoperative shoulder function was measured using the Disability of Arm, Shoulder, and Hand (DASH) questionnaire.
  
  
  RESULTS
  The incidence of microscopic nodal metastasis was 15.2%. For first year posttreatment, the mean DASH score was 44.2. With time, there was no improvement in shoulder function despite targeted physiotherapy (P = .09), and the second postoperative year mean DASH score was 46.3. The degree of daily activity affected was rated as moderate to very limited, and 30% of the patients had at least moderate shoulder pain at rest.
  
  
  CONCLUSIONS
  Shoulder dysfunction after SND for recurrent NPC is significant and persistent. Given the low incidence of microscopic nodal metastasis in such circumstances, routine SND is not recommended.
authors.affiliation: Centre for Nasopharyngeal Carcinoma Research, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong SAR, China chanjyw@gmail.com.
authors.forename: Jimmy Yu Wai
authors.initials: JY
authors.lastname: Chan
authors.affiliation: Centre for Nasopharyngeal Carcinoma Research, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong SAR, China.
authors.forename: Stanley Thian Sze
authors.initials: ST
authors.lastname: Wong
authors.affiliation: Centre for Nasopharyngeal Carcinoma Research, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong SAR, China.
authors.forename: Richie Chiu Lung
authors.initials: RC
authors.lastname: Chan
authors.affiliation: Centre for Nasopharyngeal Carcinoma Research, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong SAR, China.
authors.forename: William Ignace
authors.initials: WI
authors.lastname: Wei
mesh_terms: D000203:Activities of Daily Living; D002277:Carcinoma; D004185:Disability Evaluation; D005260:Female; D006723:Hong Kong; D006801:Humans; D015994:Incidence; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D037981:Neck Dissection / Q000009:adverse effects*; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D010147:Pain Measurement; D010611:Pharyngectomy; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D016879:Salvage Therapy; D012782:Shoulder / Q000503:physiopathology*; D013524:Surgical Flaps
keywords: DASH questionnaire; recurrent nasopharyngeal carcinoma; selective neck dissection; shoulder dysfunction; spinal accessory nerve