Selective Neck Dissection of Anatomically Appropriate Levels Is as Efficacious as Modified Radical Neck Dissection for Elective Treatment of the Clinically Negative Neck in Patients With Squamous Cell Carcinoma of the Upper Respiratory and Digestive Tracts

Abstract

Hypothesis:Patients with primary squamous cell carcinomas of the upper respiratory and digestive tracts with a greater than 20% probability of occult cervical metastases but with nodes clinically negative for metastatic disease warrant elective treatment of the neck for prognostic, diagnostic, and therapeutic purposes.

Impact of Elective Neck Dissection vs Observation on Regional Recurrence and Survival in cN0-Staged Patients With Squamous Cell Carcinomas of the Upper Aerodigestive Tract

“…[18][19][20] Up to the late 1960s, RND remained the unquestioned standard surgical approach. Based on anatomic observations, a more conservative technique has been proposed.…”

Conservative Neck Dissection in Oral Cancer Patients: a 5 Year Retrospective Study in Malaysia

“…Clayman and Frank (1998) found that, despite clear guidelines, the anatomical boundaries in a SND are not as well defined as in a MRND, leading to increased rate of out-of-field recurrences. This outcome can also be affected by the operator's experience and judgement.…”

Classification and Terminology of Neck Dissections

“…Finally, the anterolateral neck dissection groups these two previous surgical procedures together so that levels II, III, IV and VI are removed. It is important to emphasize the fact that the posterior border of dissection in all these selective procedures, except for the anterior dissection, is the cutaneous branches of the cervical plexus [18]; otherwise the risk of neck recurrences can be high [19,20]. Another aspect to be taken into consideration is the fact that although the spinal accessory nerve, the internal jugular vein, and the sternocleidomastoid muscle are preserved in the majority of these types of dissections, there is no reason why at least one of these three nonlymphatic structures cannot be sacrified [14].…”