Superselective neck dissection: rationale, indications, and results

Abstract

It has been established that an appropriately indicated selective neck dissection can achieve the same oncologic results as more extensive dissections. An even more modified selective neck dissection, termed superselective neck dissection, involves the compartmental removal of the fibrofatty tissue contents within the defined boundaries of two or fewer contiguous neck levels. Evidence from retrospective studies suggests that superselective neck dissection (SSND) is oncologically sound for two indications: elective treatment of the clinically N0 neck and salvage treatment of persistent lymph node disease after chemoradiotherapy. While there is broader support for the former scenario, evidence that SSND may constitute optimal treatment in the latter is in conformity with the trend toward developing surgical techniques that provide better functional outcomes without compromising efficacy.

Changing trends in the management of the neck in oropharyngeal squamous cell carcinoma

“…However, a planned neck dissection after definitive CRT is unnecessary for all patients with regional metastases, and, in cases of complete response (CR), planned neck dissections are currently commonly omitted . If residual lymph node metastasis persists in 1 neck level after definitive CRT, effects of comprehensive and superselective neck dissection are reported to be equal . In addition, knowing the generally favorable prognosis of HPV‐associated oropharyngeal SCC, many prospective studies pursue further treatment intensity deescalation without impairment in prognosis .…”

Efficacy of Superselective Neck Dissection in Detecting Metastasis in Patients with cN0 Papillary Thyroid Carcinoma at High Risk of Lateral Neck Metastasis

“…Historically, SSND was first used for early laryngeal or hypopharyngeal cancer, especially for localized residual disease after radio- or chemo-radiotherapy [11,12]. Recently, it was also applied to thyroid cancer for early diagnosis and treatment [7,26,27] because the results of radiological examinations and FNA guided by B-mode ultrasound were not satisfactory [28,29].…”

“…It was first used to treat early stage laryngeal or hypopharyngeal cancer and is now employed for head and neck cancer followed by chemo-radiotherapy [12]. We hypothesized that early and accurate diagnosis and treatment of lateral cervical LN metastasis in patients with thyroid cancer not only could decrease the risk of metastasis, but also help in the postoperative review of patients.…”

Shoulder symptoms and quality of life impact of limited neck dissection after de‐intensified chemoradiotherapy: Secondary analysis of two prospective trials

“…Neck dissections can lead to shoulder/neck pain and stiffness that affect function, recreation, and ability to work . Results from the use of more limited posttreatment neck dissection suggest no compromise of cancer outcomes and improved quality of life (QOL) . Nonetheless, there is likely some QOL impact.…”