Analysis of radical neck dissections in the treatment of cervical metastases

Abstract

A report of the total experience and end results of 519 radical neck dissections in 441 patients treated from 1940 through 1958 is presented. The primary cancer was located in the oral cavity in 36 per cent, in the laryngopharyngeal area in 43 per cent and in the thyroid in 6 per cent. Sixty per cent presented metastases at the first examination. Bilateral nodal enlargement was present at the initial examination in 9 per cent. Single nodal involvement was recorded in 46 per cent and multiple nodes in the same neck in 31 per cent. The histology was predominantly differentiated squamous cell carcinoma (85 per cent). Thirty-one cases of adenocarcinoma include twenty-seven thyroid tumors. The absolute five year survival for the entire group (single and bilateral) of 441 patients is 32.4 per cent and for the determinate group 35 per cent. An operative mortality of 5.2 per cent is reported. In the group requiring single neck dissections the absolute five year survival is 38 per cent and for the determinate group 41.6 per cent. In the 107 patients with bilateral metastases, 81 had bilateral neck dissection. Three of these were performed simultaneously, with one patient surviving over five years. The postoperative mortality for this group was 2.4 per cent. Five of the sixteen patients who survived after bilateral neck dissection had thyroid cancers, in eight it was located in the larynx, and in one each in the hypopharynx, tonsil and soft palate. End results are presented for six types of procedures employed in this series. The combined procedure of resection of the primary lesion in continuity with radical neck dissection in which no palpable nodes are present offers the best results. In the group of 441 patients, histologic examination of the neck dissection specimens revealed no evidence of metastatic cancer in the lymph nodes in fifty-three patients. Retrospective evaluation of so-called “elective” neck dissections (thirty-four patients) yielded positive nodes in 23 per cent.