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Selective Neck Dissection in the Management of the Clinically Node‐Negative Neck
Author(s) -
Sefik Hosal A.,
Carrau Ricardo L.,
Johnson Jonas T.,
Myers Eugene N.
Publication year - 2000
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1097/00005537-200012000-00011
Subject(s) - medicine , neck dissection , lymph node , pathological , surgery , incidence (geometry) , dissection (medical) , radiology , carcinoma , physics , optics
Objective To evaluate the efficacy of the selective neck dissection (SND) in the management of the clinically node‐negative neck. Study Design Case histories were evaluated retrospectively. Methods The results of 300 neck dissections performed on 210 patients were studied. Results The primary sites were oral cavity (91), oropharyn‐ (30), hypopharyn‐ (16), and laryn‐ (73). Seventy‐one necks (23%) were node positive on pathological e‐amination. The number of positive nodes varied from 1 to 9 per side. Of necks with positive nodes, 17 (24%) had e‐tracapsular spread. The median follow‐up was 41 months. Recurrent disease developed in the dissected neck of 11 patients (4%). Two recurrences developed outside the dissected field. The incidence of regional recurrences was similar in patients in whom nodes were negative on histological e‐amination (3%) when compared with patients with positive nodes without e‐tracapsular spread (4%). In contrast, regional recurrence developed in 18% of necks with e‐tracapsular spread. This observation was statistically significant. Patients having more than two metastatic lymph nodes had a higher incidence of recurrent disease than the patients with carcinoma limited to one or two nodes. Recurrence rate in the pathologically node positive (pN+) necks was comparable to recurrence in those pathologically node negative (pN0) necks in the patients who did not have irradiation. Conclusion SND is effective for controlling neck disease and serves to detect patients who require adjuvant therapy.