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

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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.

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Authors and Affiliations

  1. Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA

    K. Thomas Robbins

  2. ENT Clinic, University of Udine, Piazzale S. Maria della Misericordia, 33100, Udine, Italy

    Alfio Ferlito & Alessandra Rinaldo

  3. Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, USA

    Jatin P. Shah

  4. Department of Head and Neck Surgery, Head and Neck Oncology Program, St Luc University Hospital and Cancer Center, Brussels, Belgium

    Marc Hamoir

  5. Department of Otolaryngology-Head and Neck Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands

    Robert P. Takes

  6. Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia

    Primož Strojan

  7. Head and Neck Surgery and Oncology Unit, A.R.M. Center for Advanced Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel

    Avi Khafif

  8. Departments of Surgery and Otolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA

    Carl E. Silver

  9. Department of Otorhinolaryngology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

    Jesus E. Medina

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  1. K. Thomas Robbins
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  2. Alfio Ferlito
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  3. Jatin P. Shah
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  4. Marc Hamoir
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  6. Primož Strojan
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  7. Avi Khafif
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  9. Alessandra Rinaldo
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Correspondence to Alfio Ferlito.

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Robbins, K.T., Ferlito, A., Shah, J.P. et al. The evolving role of selective neck dissection for head and neck squamous cell carcinoma. Eur Arch Otorhinolaryngol 270, 1195–1202 (2013). https://doi.org/10.1007/s00405-012-2153-x

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  • DOI: https://doi.org/10.1007/s00405-012-2153-x

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