Bilateral radical neck dissection

Abstract

From January 1960 to December 1977, 61 patients had a simultaneous one-stage bilateral neck dissection with or without excision of the primary lesion, while 63 patients had a therapeutic second (two stage) neck dissection performed by our service. In ten patients, one or both of the internal jugular veins and spinal accessory nerve were preserved. Patients in both groups were staged, using the American Joint Commission 1977 clinical classification. All the pathologic specimens had lymph node clearance done. Simultaneous bilateral neck dissection, in the present study, has an operative mortality of 10%, with 11% life-threatening complications and with 62% significant postoperative facial swelling. There is an overall three- and five-year survival rate of 20% and 12.5%. Patients who had bilateral staged neck dissection had complications seen in 54%, with a 3.2% mortality rate. The overall three- and five-year survival in this group of patients was 60% and 38%, respectively.

Internal Jugular Vein Patency in Patients Undergoing Microvascular Reconstruction

“…Preservation of the sternocleidomastoid muscle may provide protection against carotid blowout in the event of wound infection or a pharyngocutaneous fistula and may improve cosmetic outcome. Maintenance of an internal jugular vein decreases the significant facial and cervical edema, with possible airway compromise, that one sees in bilateral radical neck dissections 16,17 . When an internal jugular vein is not preserved, measurements of intracranial pressures show dangerous fluctuations 18 .…”

Internal to external jugular vein bypass allowing for simultaneous bilateral radical neck dissection

“…Bilateral resection of IJVs, either in a single‐ or two‐stage approach, disrupts cerebral outflow, increasing ICP . Increase in ICP can consequently result in physiological changes that lead to systemic hypertension, facial edema, laryngeal edema with respiratory distress, opthalmoplegia, blindness, and stroke . These complications may arise during staged or simultaneous bilateral neck dissections .…”

Metástases cervicais bilaterais no carcinoma epidermóide de cabeça e pescoço: tratamento cirúrgico em um ou dois tempos

“…Estudos anteriores sobre os esvaziamentos bilaterais abordavam outro problema, o da morbi-mortalidade do procedimento, inerente à técni-ca de esvaziamento cervical empregada no passado. Razack et al 3 relataram resultados semelhantes entre os esvaziamentos bilaterais realizados em um ou dois tempos, com sobrevida a 5 anos de 12% e 16%, respectivamente. A recidiva cervical contralateral, porém, pode apresentar um significado diferente em comparação com a doença bilateral.…”

“…O controle regional pode ter implicações sobre a qualidade de vida, porém o esvaziamento bilateral (radical) está associado à elevada morbi-mortalidade, especialmente quando em continuidade com a ressecção do tumor primário em pacientes debilitados por doença em estádio avançado 3,6 . A deiscência da ferida operatória, com a exposição do feixe vásculo-nervoso bilateralmente, configura uma situação de elevado risco para estes pacientes.…”