Modified radical neck dissection in cancer of the mouth, pharynx, and larynx

Abstract

A retrospective analysis of 390 determinate radical neck dissections (RND) performed for cancers of the mouth, pharynx, and larynx was carried out. There were 75 patients (19%) who had a modified RND. These were separately analyzed and the outcome was compared to those who had a standard total RND. Our goal was to assess the effectiveness of modified RND in controlling disease in the neck, and to identify its impact on survival and quality of life. Overall neck recurrence rate in the entire modified RND group was 28%, 35% in the partial RND, and 25% in the comprehensive modified RND. Neck recurrence rate was no worse in the comprehensive modified RND for N0 and N1 cases, but increased significantly (as compared to the group of patients with standard RND) in the N2 and N3 cases (52% vs. 33%). Treatment of neck recurrences following modified RND was primarily by surgery, with a 48% 3-year disease-free survival. Overall survival was the same for modified RND (68%) and for standard total RND (63%). This was true for all N stages individually. The morbidity of standard total RND is discussed and the goals of modified RND are analyzed. Definitions and a standardized nomenclature for the various types of modified RND are suggested for uniformity of reporting.

Cervical lymph node metastatic patterns of squamous carcinomas in the upper aerodigestive tract

“…Functional neck dissection was initially introduced into clinical practice by Bocca, and in recent years, this has been advocated for different types of primary carcinomas (Khafif et al, 1990). Indeed, functional neck dissection resulted in regional control rates similar to those acheived by RND, not only in carcinoma of the larynx but also for cancers at other sites especially when patients were carefully selected (Bocca et al, 1984).…”

Management of Gingivobuccal Complex Cancer

“…5,19,20 In patients with clinical N1 disease and selected N2 disease, am odified radical neck dissection may be done for better cosmetic and functional results. [19][20][21] Preservation of the spinal accessory nerve, internal jugular vein (IJV) and sternocleidomastoid muscle is done in the form of am odified radial neck dissection (MRND ; Table 3). RND, however,i ss till appropriate for patients with massive lymphadenopathy (N3 disease), multiple positive nodes involving the spinal accessory nerve and/or the IJV,r esidual or recurrent neck disease after radiotherapy and gross extranodal spread.…”

Outcome of treatment for advanced cervical metastatic squamous cell carcinoma

“…There was a 61% actuarial survival rate and 86% neck control rate at 5 years, but the authors were unable to demonstrate any statistical difference between the two dissection groups. In a similar study, Khafif et al 29 examined 118 patients with N2 to N3 disease and found that the 3-year actual survival and neck control rates were 56% and 64%, respectively.…”