Functional Neck Dissection for the Clinically Negative Neck: Effectiveness and Controversies

Abstract

This study was performed to evaluate the effectiveness of functional neck dissection in controlling metastasis to the clinically negative (cN0) neck, focusing on recurrences in the pathologically negative (pN0) neck and the role of extracapsular spread in the cN0 neck. A series of 172 patients (253 dissected fields) treated for cN0 laryngeal or hypopharyngeal cancer with a 5-year minimum follow-up is presented. Occult metastasis was observed in 30% of the patients. Extracapsular spread was present in 39% of the positive nodes. The neck recurrence rate was 5.2%. Surgical specimens from cases of neck recurrence in pN0 necks were reevaluated for micrometastasis by immunostaining with antibody for cytokeratins. The immunohistochemical findings were positive in 1 of 4 cases. Functional neck dissection provides good neck control and survival rates for the cN0 neck. The accurate prognostic significance of extracapsular spread in cN0 necks is still unknown. Micrometastasis alone may be insufficient to explain recurrences in pN0 necks.

Management of the Patients with Hypopharyngeal Cancer: Eight-Year Experience of Miyagi Cancer Center in Japan

“…Elective contralateral neck dissection is controversial (Nishijima et al 1991;Anderson et al 1996;Lassaletta et al 2002). Four of our patients experienced contralateral regional recurrence, but they were salvaged by ND at the time of recurrence.…”

“…Although radical surgery with subsequent reconstruction of the cervical esophagus by free jejunum transfer has become a relatively easy procedure for advanced cancer recently, the survival rate in such cases remains fairly poor. In hypopharyngeal cancer, there are various problematic issues such as the high frequency of distant metastasis, occurrence of multiple primary cancers (Schwartz et al 1994;Ogawa et al 1999), choice of therapy such as radiation and surgery for the primary lesion, therapy for retropharyngeal lymph node (Hasegawa and Matsuura 1994), and indication for contralateral elective neck dissection (Nishijima et al 1991;Anderson et al 1996;Lassaletta et al 2002). We thought that these many problems are compound and make survival rate decline.…”

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

“…The election of neck dissection type is based on the preoperative staging and the anatomical subsite of the primary [7]. Previous data suggest that FND or SND offers an effective and oncological safe surgical procedure in selected patients with clinically positive metastatic nodes in the neck [5,10,11,15]. However, reports related to the complication rates are scarce.…”

“…As previous authors highlighted, the FND philosophy described by Suarez may be combined with the pattern of metastasis used to define SND [11], looking to decrease morbidity rates associated to these types of surgeries. However, complications like surgical wound dehiscence, surgical site infection (SSI), and seroma; vascular complications as hemorrhage, chyle leakage (CL), and neurological complications still occur [12,13], causing a significant impact on the quality of life of some patients and increasing the health-care expenditure, due to prolonged hospital stay, need for reoperations, permanent neurological sequelae, and sometimes, a fatal outcome.…”

Contralateral Cervical Lymph Node Metastases in Pyriform Sinus Carcinoma

“…Squamous cell carcinoma of the pyriform sinus is characterized by an aggressive clinical behavior and high risk of spreading to the lymphatic system. According to the data in the literature, the incidence of metastatic neck nodes at the time of initial observation came to approximately 60%‐83% of cases, whereas in 30%‐50% of cases clinically staged as N0, occult lymph node metastases were later revealed histologically 1–4 …”