LARYNGOSCOPE, vol.110, no.12, pp.2037-2040, 2000 (SCI-Expanded)
Objective: To evaluate the efficacy of the selective neck dissection (SND) in the management of the clinically node-negative neck. Study Design: Case histories were evaluated retrospectively, Methods: The results of 300 neck dissections pet-formed on 210 patients were studied, Results: The primary sites were oral cavity (91), oropharynx (30), hypopharynx (16), and larynx (73), Seventy-one necks (23%) were node positive on pathological examination. The number of positive nodes varied from 1 to 9 per side. Of necks with positive nodes, 17 (24%) had extracapsular spread. The median follow-up was 41 months. Recurrent disease developed in the dissected neck of 11 patients (4%). Two recurrences developed outside the dissected field. The incidence of regional recurrences was similar in patients in whom nodes mere negative on histological examination (3%) when compared with patients with positive nodes without extracapsular spread (4%). In contrast, regional recurrence developed in 18% Of necks with extracapsular spread. This observation was statistically significant. Patients having more than two metastatic lymph nodes had a higher incidence of recurrent disease than the patients with carcinoma Limited to one or two nodes. Recurrence rate in the pathologically node positive (pN+) necks was comparable to recurrence in those pathologically node negative (pN0) necks in the patients who did not have irradiation. Conclusion: SND is effective for controlling neck disease and serves to detect patients who require adjuvant therapy.