Efficacy of selective neck dissection: a review of 503 cases of elective and therapeutic treatment of the neck in squamous cell carcinoma of the upper aerodigestive tract.

OBJECTIVE: The purpose of this study was to evaluate the efficacy of selective neck dissection (SND) in elective and therapeutic treatment of the neck.

METHODS: A retrospective review was undertaken of 503 previously untreated patients undergoing 711 SNDs as a part of initial therapy for squamous cell carcinoma of the larynx, oral cavity, oropharynx, and hypopharynx from August 1986 to June 1997 at a single institution. Lymph nodes were pathologically negative in 249 and positive in 254 patients. Postoperative radiotherapy was given to 14.5% of the node-negative and 62.2% of the node-positive patients. The median follow-up interval was 41 months.

RESULTS: The 3-year regional recurrence rates estimated according to Kaplan-Meier were as follows: pN0, 4.7%; pN1, 4.9%; pN2, 12.1%. A comparison of recurrence rates with respect to the extent of neck disease and postoperative radiotherapy demonstrated a tendency to an improved regional control in irradiated patients with one metastasis and a distinctly improved regional control in patients with multiple metastases or metastases with extracapsular spread.

CONCLUSION: The results achieved with SND compare favorably with the results reported for modified radical neck dissection. The application of SND might be extended to more advanced neck disease.