Analysis of prognostic factors for recurrence after neck dissection.

Abstract

To analyze retrospectively several characteristics to verify the existence of further prognostic factors besides those already known for recurrence after neck dissection. From 1976 to 1993, 1 surgeon performed 1097 neck dissections as single surgical events in 705 patients. Radical neck dissection was performed only in the presence of fixed nodes and functional neck dissection in cases with mobile nodes or without detectable nodes (N0). Functional neck dissection was performed on laryngeal or hypopharyngeal N0 tumors without the dissection of the first level. External beam radiotherapy (RT) was performed based on the following conditions: microscopically positive margins of tumor, more than 2 positive nodes without capsular rupture (pN+R-), or capsular rupture (pN+R+). Division of Otolaryngology, General Hospital of Pordenone, northeastern Italy. Nodal recurrences were observed in 38 patients (5.4%). Patient sex and age, histological grading and staging of primary tumor, second tumors, number of nodes, type of neck staging, surgeon's experience, type of dissection, alterations to the dissection, number of pN+R-, and postoperative RT were not significantly related to the recurrence. The clinical staging of nodes at greater than N1 and/or fixed; the neck levels IV, V, and multiple levels; previous RT with or without chemotherapy; the absence of a synchronous tumor operation; the assessment of the dissection as less than radical; the overall number of pN+ at 2 or more; and the presence of pN+R+ were related to higher recurrence rates. The treatment policy used herein is effective for pN+R-. A more aggressive multidisciplinary approach might be suggested for N2 and N3 and/or fixed nodes; nodes at levels IV, V, or multiple; nodes dissected less than radically; or pN+R+.