Complications after Functional Neck Dissection in Head and Neck Cancer Patients: An Observational, Retrospective, Single-Centre Study

Abstract

<b><i>Introduction:</i></b> Functional neck dissection (FND) represents a surgical procedure usually associated with less morbidity. <b><i>Methods:</i></b> An observational, retrospective, analysis of patients diagnosed with any type of head and neck malignancy was designed to summarize and report the incidence of postoperative complications in patients undergoing FND including just those levels described for selective neck dissections in a tertiary university hospital between June 2016 and June 2019. <b><i>Results:</i></b> 131 patients met the inclusion criteria. The total number of sides studied was 200. 40.5% of the patients suffer a complication in the postoperative period, being the spinal accessory nerve (SAN) injury the most common complication (10%). We did not find any statistical ­correlation between the previous organ-preservation treatments and surgical complications (<i>p</i> = 0.207). An advanced T stage (<i>p</i> = 0.009) and the need of bilateral FND (<i>p</i> = 0.034) were significantly correlated with a higher risk of surgical complications. <b><i>Conclusion:</i></b> FND represents a useful technique. In this study, 40.5% of the patients suffer a complication in the postoperative period, being the SAN injury the most common complication. However, these data contribute to increasing our knowledge about surgical complications related to FND.

The role of elective neck dissection in T1 and T2 nasal cavity squamous cell carcinomas

“…Although complications are rare in experienced hands [ 9 , 10 ], the low risk of RR or occult lymph node metastasis does not justify END in all stage I–II nasal cavity SCCs. The overall NNT of our cohort was 8, which indicates that 8 patients need END to prevent one RR.…”

“…And third, the retrospective study-design including a low number of patients with limited events and partially short follow-up times represent further flaws. Nonetheless, considering the current literature regarding T1 and T2 sinonasal SCCs with patient cohorts ranging between 10 and 35 proves that our cohort is representative [ 6 , 9 , 11 , 17 , 20 , 23 , 24 ].…”

“…3 Risk for regional recurrence. The risk for occurrence of a regional recurrence (RR) is indicated according to our proposed risk score and performance of elective neck dissection (END) Moreover, we believe that END should be favored over elective neck irradiation in patients with higher estimated risks for RR due to following reasons: (i) still low complication rates and morbidity associated with END [9,10]; (ii) END provides additional beneficial histopathological information (occult lymph node metastasis) resulting in accurate staging and also guides the future possibility of adjuvant chemotherapy; (iii) avoidance of radiation induced sideeffects, such as xerostomia or mucositis [22]; and (iv) and irradiation could be preserved as curative treatment option in the case of neck failure, which might be severely limited by possible long-term complications such as spinal cord toxicity if irradiation was applied electively before.…”

“…Although complications are rare for experienced head and neck surgeons, they naturally occur also after elective neck dissection (END). Shoulder immobility or spinal accessory nerve palsy is reported as the most common complication occurring in 10% of patients after selective or modified radical neck dissection [ 9 ], but with preservation of normal shoulder function in 93.8% of cases [ 10 ].…”

Effect of Manual Pressure Release and Scapular Stabilization Exercises on Myofascial Pain Syndrome Following Neck Dissection Surgery

“…Furthermore, excision of all lymph nodes normally excised during RND was referred to as modified radical neck dissection (MRND) but keeping one or more non-lymphatic components such as internal jugular vein, spinal accessory nerve, and sternocleidomastoid muscle intact [3] . A type of lymphadenectomy known as selective neck dissection (SND) preserves one or even several groups of cervical lymph nodes [6] .…”