The evolving role of selective neck dissection for head and neck squamous cell carcinoma.

Abstract

Neck dissection is an important part of the surgical treatment of head and neck squamous cell carcinoma (HNSCC). The historical concept of neck dissection implied the removal of all lymph node-bearing tissue in the neck, which began in the late nineteenth century. However, more conservative variations of neck dissection have been performed and promoted as well. Anatomic, pathologic, clinical investigations, and prospective studies have demonstrated that the lymphatic dissemination of HNSCC occurs in predictable patterns. Supported by these studies, selective neck dissection (SND), which consists of the removal of select levels of lymph nodes in the neck that have the highest risk of harboring undetected metastases, has become widely accepted in the treatment of the clinically uninvolved neck. More recently, evidence supports using SND in a therapeutic setting in selected cases of HNSCC with limited metastatic disease. Additionally, even more targeted dissections referred to as super-selective neck dissection have been explored for selected patients undergoing elective node dissection for supraglottic cancer and as an adjuvant therapy for salvage of residual lymphadenopathy confined to a single neck level following chemoradiation. In the future, the trend to tailor treatment to individual patients and to limit toxicity and morbidity may further increase the use of SND. The indications have to be guided by further research, in relation with non-surgical treatment options while optimizing oncological effectiveness.

• Authors: K Thomas Robbins, Alfio Ferlito, Jatin P Shah, Marc Hamoir, Robert P Takes, Primož Strojan, Avi Khafif, Carl E Silver, Alessandra Rinaldo, Jesus E Medina
• Journal: European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery (Eur Arch Otorhinolaryngol) Vol. 270 Issue 4 Pg. 1195-202 (Mar 2013) ISSN: 1434-4726 [Electronic] Germany
• PMID: 22903756 (Publication Type: Journal Article, Review)

Topics

• Carcinoma, Squamous Cell (drug therapy, pathology, radiotherapy, surgery)
• Chemotherapy, Adjuvant
• Humans
• Lymph Node Excision (methods)
• Lymphatic Metastasis (pathology)
• Neck Dissection (methods)
• Neoplasm, Residual (drug therapy, pathology, radiotherapy, surgery)
• Otorhinolaryngologic Neoplasms (drug therapy, pathology, radiotherapy, surgery)
• Radiotherapy, Adjuvant
• Risk
• Salvage Therapy
• Treatment Outcome