Skip to main content
Top
Published in: European Journal of Plastic Surgery 3/2015

01-06-2015 | Original Paper

Modified radical neck dissection vs. selective neck dissection: an analysis of lymph node yield and post-surgical outcomes

Authors: Jason T. Toppi, Frank Bruscino-Raiola

Published in: European Journal of Plastic Surgery | Issue 3/2015

Login to get access

Abstract

Background

Modified radical neck dissection (MRND) and selective neck dissection (SND) are widely used techniques for the management of metastatic squamous cell carcinoma (SCC) involving the lymph nodes of the neck. This study compared the yield of lymph nodes for both techniques and evaluated clinically relevant outcomes.

Methods

A retrospective study design was utilised. Patients undergoing either the MRND or SND between January 2010 and March 2012 for metastatic SCC were eligible for inclusion. The primary outcome was mean number of lymph nodes extracted per neck level. Secondary outcomes were all cause mortality, regional recurrence and complications.

Results

Fifty-two patients who underwent 58 neck dissections (12 MRND and 46 SND) were included in the final analysis with a mean follow-up of approximately 1 year for both groups. No significant differences were observed between the groups with regards to follow-up time, age or gender. No significant differences were observed in terms of surgical complications including haematoma, infection and thromboembolic complications. Both the MRND and SND were found to be similar in terms of the number of lymph nodes extracted per anatomical neck level (p > 0.05 for levels I–V). There were no significant differences between the MRND and SND in terms of regional recurrence and overall survival.

Conclusions

Our results showed no difference between the MRND and SND in terms of lymph node yield after adjusting for the number of anatomical levels dissected. The MRND and SND also demonstrated similar complication profiles and rates of recurrence and survival.
Level of evidence: Level III, risk/prognostic study
Literature
1.
go back to reference Silver CE, Ferlito A (1996) Surgery for cancer of the larynx and related structures, 2nd edn. Saunders, Philadelphia Silver CE, Ferlito A (1996) Surgery for cancer of the larynx and related structures, 2nd edn. Saunders, Philadelphia
2.
go back to reference Ferlito A, Rinaldo A, Robbins KT, Silver CE (2006) Neck dissection: past, present and future? The Journal of Laryngology and Otology 120(2):87–92CrossRefPubMed Ferlito A, Rinaldo A, Robbins KT, Silver CE (2006) Neck dissection: past, present and future? The Journal of Laryngology and Otology 120(2):87–92CrossRefPubMed
4.
go back to reference Warren JC (1839) Surgical observations on tumours: with cases and operations. Churchill, John Warren JC (1839) Surgical observations on tumours: with cases and operations. Churchill, John
5.
go back to reference Crile GW (1905) On the surgical treatment of cancer of the head and neck. With a summary of one hundred and twenty-one operations performed on one hundred and five patients. Trans South Surg Gynecol Assoc 18:108–127 Crile GW (1905) On the surgical treatment of cancer of the head and neck. With a summary of one hundred and twenty-one operations performed on one hundred and five patients. Trans South Surg Gynecol Assoc 18:108–127
6.
go back to reference Crile GW (1906) Excision of cancer of the head and neck with special reference to the plan of dissection based on one hundred and thirty-two operations. JAMA : the journal of the American Medical Association 47:1780–1786CrossRef Crile GW (1906) Excision of cancer of the head and neck with special reference to the plan of dissection based on one hundred and thirty-two operations. JAMA : the journal of the American Medical Association 47:1780–1786CrossRef
7.
go back to reference Suárez O (1963) El problema de las metastasis linfáticas y alejadas del cáncer de laringe e hipofaringe. Rev Otorrinolaringol 23:83–99 Suárez O (1963) El problema de las metastasis linfáticas y alejadas del cáncer de laringe e hipofaringe. Rev Otorrinolaringol 23:83–99
8.
go back to reference Bocca E, Pignataro O (1967) A conservation technique in radical neck dissection. The Annals of Otology, Rhinology, and Laryngology 76(5):975–987CrossRefPubMed Bocca E, Pignataro O (1967) A conservation technique in radical neck dissection. The Annals of Otology, Rhinology, and Laryngology 76(5):975–987CrossRefPubMed
9.
go back to reference Byers RM (1985) Modified neck dissection. A study of 967 cases from 1970 to 1980. Am J Surg 150(4):414–421CrossRefPubMed Byers RM (1985) Modified neck dissection. A study of 967 cases from 1970 to 1980. Am J Surg 150(4):414–421CrossRefPubMed
10.
go back to reference Gourin CG (2004) Is selective neck dissection adequate treatment for node-positive disease? Archives of Otolaryngology–head & Neck Surgery 130(12):1431–1434CrossRef Gourin CG (2004) Is selective neck dissection adequate treatment for node-positive disease? Archives of Otolaryngology–head & Neck Surgery 130(12):1431–1434CrossRef
11.
go back to reference Wang JT, Palme CE, Wang AY, Morgan GJ, Gebski V, Veness MJ (2013) In patients with metastatic cutaneous head and neck squamous cell carcinoma to cervical lymph nodes, the extent of neck dissection does not influence outcome. J Laryngol Otol 127(Suppl 1):S2–S7CrossRefPubMed Wang JT, Palme CE, Wang AY, Morgan GJ, Gebski V, Veness MJ (2013) In patients with metastatic cutaneous head and neck squamous cell carcinoma to cervical lymph nodes, the extent of neck dissection does not influence outcome. J Laryngol Otol 127(Suppl 1):S2–S7CrossRefPubMed
12.
go back to reference Yanai Y, Sugiura T, Imajyo I, Yoshihama N, Akimoto N, Kobayashi Y, Hayashi K, Fujinaga T, Shirasuna K, Takenoshita Y, Mori Y (2012) Retrospective study of selective submandibular neck dissection versus radical neck dissection for N0 or N1 necks in level I patients with oral squamous cell carcinoma. J Oncol 2012:634183CrossRefPubMedCentralPubMed Yanai Y, Sugiura T, Imajyo I, Yoshihama N, Akimoto N, Kobayashi Y, Hayashi K, Fujinaga T, Shirasuna K, Takenoshita Y, Mori Y (2012) Retrospective study of selective submandibular neck dissection versus radical neck dissection for N0 or N1 necks in level I patients with oral squamous cell carcinoma. J Oncol 2012:634183CrossRefPubMedCentralPubMed
13.
go back to reference Dias FL, Lima RA, Manfro G, Barbosa MM, Salviano S, Rocha RM, Marques AS, Cernea CR, Kligerman J (2009) Management of the N0 neck in moderately advanced squamous carcinoma of the larynx. Otolaryngology–head and neck surgery : Otolaryngol Head Neck Surg 141(1):59–65CrossRefPubMed Dias FL, Lima RA, Manfro G, Barbosa MM, Salviano S, Rocha RM, Marques AS, Cernea CR, Kligerman J (2009) Management of the N0 neck in moderately advanced squamous carcinoma of the larynx. Otolaryngology–head and neck surgery : Otolaryngol Head Neck Surg 141(1):59–65CrossRefPubMed
14.
go back to reference Patel RS, Clark JR, Gao K, O'Brien CJ (2008) Effectiveness of selective neck dissection in the treatment of the clinically positive neck. Head Neck 30(9):1231–1236CrossRefPubMed Patel RS, Clark JR, Gao K, O'Brien CJ (2008) Effectiveness of selective neck dissection in the treatment of the clinically positive neck. Head Neck 30(9):1231–1236CrossRefPubMed
15.
go back to reference Robbins KT, Doweck I, Samant S, Vieira F (2005) Effectiveness of superselective and selective neck dissection for advanced nodal metastases after chemoradiation. Archives of Otolaryngology–head & Neck Surgery 131(11):965–969CrossRef Robbins KT, Doweck I, Samant S, Vieira F (2005) Effectiveness of superselective and selective neck dissection for advanced nodal metastases after chemoradiation. Archives of Otolaryngology–head & Neck Surgery 131(11):965–969CrossRef
16.
go back to reference Schiff BA, Roberts DB, El-Naggar A, Garden AS, Myers JN (2005) Selective vs modified radical neck dissection and postoperative radiotherapy vs observation in the treatment of squamous cell carcinoma of the oral tongue. Archives of Otolaryngology–head & Neck Surgery 131(10):874–878CrossRef Schiff BA, Roberts DB, El-Naggar A, Garden AS, Myers JN (2005) Selective vs modified radical neck dissection and postoperative radiotherapy vs observation in the treatment of squamous cell carcinoma of the oral tongue. Archives of Otolaryngology–head & Neck Surgery 131(10):874–878CrossRef
17.
go back to reference Muzaffar K (2003) Therapeutic selective neck dissection: a 25-year review. Laryngoscope 113(9):1460–1465CrossRefPubMed Muzaffar K (2003) Therapeutic selective neck dissection: a 25-year review. Laryngoscope 113(9):1460–1465CrossRefPubMed
18.
go back to reference Agrama MT, Reiter D, Topham AK, Keane WM (2001) Node counts in neck dissection: are they useful in outcomes research? Otolaryngology–head and neck surgery : Otolaryngol Head Neck Surg 124(4):433–435CrossRefPubMed Agrama MT, Reiter D, Topham AK, Keane WM (2001) Node counts in neck dissection: are they useful in outcomes research? Otolaryngology–head and neck surgery : Otolaryngol Head Neck Surg 124(4):433–435CrossRefPubMed
19.
go back to reference Edge SB, American Joint Committee on Cancer (2010) AJCC cancer staging manual, 7th edn. Springer, New YorkCrossRef Edge SB, American Joint Committee on Cancer (2010) AJCC cancer staging manual, 7th edn. Springer, New YorkCrossRef
21.
go back to reference Park YM, Holsinger FC, Kim WS, Park SC, Lee EJ, Choi EC, Koh YW (2013) Robot-assisted selective neck dissection of levels II to V via a modified facelift or retroauricular approach. Otolaryngology–head and neck surgery : Otolaryngol Head Neck Surg 148(5):778–785CrossRefPubMed Park YM, Holsinger FC, Kim WS, Park SC, Lee EJ, Choi EC, Koh YW (2013) Robot-assisted selective neck dissection of levels II to V via a modified facelift or retroauricular approach. Otolaryngology–head and neck surgery : Otolaryngol Head Neck Surg 148(5):778–785CrossRefPubMed
Metadata
Title
Modified radical neck dissection vs. selective neck dissection: an analysis of lymph node yield and post-surgical outcomes
Authors
Jason T. Toppi
Frank Bruscino-Raiola
Publication date
01-06-2015
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Plastic Surgery / Issue 3/2015
Print ISSN: 0930-343X
Electronic ISSN: 1435-0130
DOI
https://doi.org/10.1007/s00238-014-1054-1

Other articles of this Issue 3/2015

European Journal of Plastic Surgery 3/2015 Go to the issue