638 Lymph node dissection in head and neck cancer—modalities, prognostic value

Abstract

Radical neck dissection (RND) was first described by Crile in 1906 about 132 procedures. A large variety of modified neck-dissections have been proposed during the past 30 years. The goal of these new procedures was to reduce the sequellae by using functional neck dissections (FND) or selective neck dissections (SND). More than a therapeutic approach the SND are diagnostic tools to know whether the neck is involved or not. In our Institution RND, FND and SND are used depending on nodal status, site and size of the primary. The nodal involvement depends widely on the primary site. The knowledge of the prognostic value of the cervical nodal involvement is based mainly on retrospective studies initiated on a large scale since more than 25 years in our Institution. This is the basis of the well selected use of the different types of neck dissection and of the use or not of elective neck dissection. The histological pattern of node involvement is the better guide for postoperative radiotherapy. The last retrospective study performed at the Institut Gustave-Roussy included 914 patients who underwent a lymph node dissection between 1980 and 1985. The primary tumor sites were oral cavity 287, hypopharynx 249, larynx 247 and oropharynx 131. We defined sentinel nodes as the first area to be involved depending on the site of the primary, either homolateral or bilateral. The prognostic factors studied, using the Cox survival model adjusted on the primary tumor site, surprisingly showed a nonsignificant value for extracapsular spread (P = 0.09), and a significant value for the number of positive nodes (P