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2b or not 2b? Shoulder function after level 2b neck dissection: A double‐blind randomized controlled clinical trial
Author(s) -
Dziegielewski Peter T.,
McNeely Margaret L.,
Ashworth Nigel,
O’Connell Daniel A.,
Barber Brittany,
Courneya Kerry S.,
Debenham Brock J.,
Seikaly Hadi
Publication year - 2020
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.32681
Subject(s) - medicine , sequela , neck dissection , randomized controlled trial , surgery , dissection (medical) , quality of life (healthcare) , range of motion , cancer , nursing
Background Selective neck dissection (SND) is a mainstay of head and neck cancer treatment. A common sequela is shoulder syndrome from spinal accessory nerve (SAN) trauma. Extensive dissection in neck levels 2 and 5 leads to SAN dysfunction. However, it is not known whether limited level 2 dissection reduces SAN injury. The purpose of this double‐blind randomized controlled trial was to determine whether omitting level 2b dissection would improve shoulder‐related quality of life and function. Methods Patients with head and neck cancers undergoing surgery were randomized 1:1 to SND without level 2b dissection (group 1) or with it (group 2) on their dominant‐hand side. Patients, caregivers, and assessors were blinded. The primary outcome was the change in the Neck Dissection Impairment Index (NDII) score after 6 months. An a priori calculation of the minimally important clinical difference in the NDII score was determined to establish a sample size of 15 patients per group (power = 0.8). Secondary outcomes included shoulder strength and range of motion (ROM) and SAN nerve conduction. The trial was registered at ClinicalTrials.gov (NCT00765791). Results Forty patients were enrolled, and 30 were included (15 per group). Six months after the surgery, group 2 demonstrated a significant median decrease in the NDII from the baseline (30 points) and in comparison with group 1, whose NDII dropped 17.5 points ( P = .02). Shoulder ROM and SAN conduction demonstrated significant declines in group 2 ( P ≤ .05). No adverse events occurred. Conclusions Level 2b should be omitted in SND when this is oncologically safe and feasible. This allows for an optimal balance between function and cancer cure.