The Laryngoscope
Lippincott Williams & Wilkins, Inc., Philadelphia
© 2002 The American Laryngological,
Rhinological and Otological Society, Inc.
Selective Neck Dissection for the Treatment
of Neck Metastasis From Squamous Cell
Carcinoma of the Head and Neck
Douglas B. Chepeha, MD, MSPH, FRCS(C); Paul T. Hoff, MD; Rodney J. Taylor, MD, MSPH;
Carol R. Bradford, MD; Theodoros N. Teknos, MD; Ramon M. Esclamado, MD
Objective: Our objective was to determine the pro-
portion of patients disease free in the neck, with the
primary site controlled, who have been treated with a
selective neck dissection (SND) for squamous cell carci-
noma (SCCa) of the upper aerodigestive tract, and who
had cervical metastasis less than 3 cm. Study Design: A
cohort of patients who fit the inclusion/exclusion crite-
ria was identified retrospectively. Then all surviving
patients were followed for a minimum of 2 years. Meth-
ods: A group of 52 patients who had 58 selective neck
dissections for cervical metastases from SCCa of the
upper aerodigestive tract were identified. The mean
age was 56 years (range, 20–85 y), there were 40 males
and 12 females, and mean follow-up was 24.5 months
(range, 1–64 mo). Twenty-six patients had clinically neg-
ative (cN0) neck examinations and 26 had clinically pos-
itive neck examinations. Postoperative radiation was
given for extracapsular spread, greater than 2 positive
nodes, T3, T4, or recurrent disease if the patient had not
received radiation before surgery. These radiation cri-
teria excluded 18 patients from postoperative radiation
treatment. Results: Kaplan-Meier survival analysis
showed that the regional control rate with the primary
site controlled was 0.94. Six patients developed recur-
rent neck disease. Three of these 6 patients were surgi-
cally salvaged. Four recurrences were in the dissected
field and 2 were out of the dissected field (level V). Con-
clusions: With similar indications for radiation therapy,
the regional control rate in this cohort is comparable to
control rates obtained with modified radical neck dis-
section. Key Words: Squamous cell carcinoma, neck dis-
section, selective neck dissection, head and neck can-
cer, positive lymph node.
INTRODUCTION
The presence of a positive cervical lymph node is an
independent predictor of poor survival.1 The positive node is
representative of an adverse tumor–host relationship and
indicates that there is a propensity for spread of disease.
There are many articles carefully delineating the pattern of
spread within the cervical lymphatics for a given primary
site.2–6 From this literature, cogent approaches have been
developed for the management of metastatic cervical dis-
ease. These approaches have traditionally been radical as
surgeons have attempted to improve survival in this popu-
lation. Procedures such as the Modified Radical Neck Dis-
section (MRND) combined with selective postoperative radi-
ation therapy have been successful in controlling disease
regionally.7 Unfortunately, local and distant recurrence
leave overall survival relatively unchanged. As understand-
ing of oncogenesis and progression of disease has improved,
some head and neck oncologists have come to hypothesize
that the value of a neck dissection may not be a radical
resection of all the regional disease. Rather, a neck dissec-
tion can provide valuable information on the systemic be-
havior of the disease and may help guide further therapy. To
further this end, and in sympathy for the morbidity that
radical neck procedures inflict on these patients, surgeons
have attempted less radical, more selective procedures.8–11
Recent data have shown that a selective neck dissection
(SND) combined with postoperative radiation therapy im-
parts less morbidity than MRND alone.12 Even though func-
tional outcome can be improved, it is critical to show that a
more selective procedure will not contribute to a decrease in
regional control. Therefore, a retrospective cohort was as-
sembled to determine the proportion of patients disease free
in the neck, with the primary site controlled, who received an
SND for squamous cell carcinoma (SCCa) of the upper aerodi-
gestive tract and had cervical metastasis less than 3 cm.
Laryngoscope, 112:434–438, 2002
From the Department of Otolaryngology (D.B.C., P.T.H., R.J.T., C.R.B.,
T.N.T.), University of Michigan Health System, Ann Arbor, Michigan; and
the Department of Otolaryngology & Communicable Diseases (R.M.E.),
Cleveland Clinic, Cleveland, Ohio, U.S.A.
Editor’s Note: This Manuscript was accepted for publication August
23, 2001.
METHODS AND MATERIALS
Send Correspondence to Douglas B. Chepeha, MD, University of
Michigan Health System, Department of Otolaryngology, 1904 Taubman
Center, 1500 East Medical Center Dr., Ann Arbor, MI 48109-0312, U.S.A.
E-mail: dchepeha@umich.edu
Design
This is a retrospective cohort study which identified pa-
tients who had a neck dissection billed between March 1993 and
Laryngoscope 112: March 2002
434
Chepeha et al.: Selective Neck Dissection