Outcomes Among Head and Neck Cancer Patients Treated with Selective Neck Dissection

Abstract

Background: Advanced head and neck squamous cell carcinomas (HNSCCs) often require a multimodality treatment approach, involving surgery, radiation, and chemotherapy. Upfront surgery for advanced HNSCC includes resecting the lymphatics that drain the primary cancer site, also known as a selective neck dissection.1–4 The aim of this study was to investigate outcomes among veterans with HNSCC who were treated with upfront surgery, as well as to describe the surgical technique for selective neck dissection. Materials and Methods: Patients with HNSCC were queried from the Washington DC Veterans Affairs Medical Center tumor registry between 2000 and 2021. Those patients with newly diagnosed HNSCC who underwent selective neck dissection as part of their surgical treatment, either with or without adjuvant therapy, were included. Clinical-pathologic data collected included age, gender, ethnicity/race, body mass index, tobacco and alcohol history, and tumor stage. The primary outcome was 3-year overall survival (OS). Secondary outcomes were cancer recurrence and distant metastases. Results: Of the 149 patients who met inclusion criteria, 37.2% had tumors of the oropharynx, followed by oral cavity (32.4%), larynx (23%), and hypopharynx (7.4%). Non-white race and older age at surgery were independently associated with worse 3-year OS (p = 0.023 and p = 0.008, respectively). Advanced tumor classification (T4a) was associated with worse 3-year OS and increased risk of cancer recurrence (p = 0.003 and p = 0.013, respectively). After treatment, 3-year OS was 55.7% for the entire cohort. Approximately 31.5% of patients developed cancer recurrence and 13% developed distant metastases after treatment with curative intent. Conclusion: OS remains poor among patients with HNSCC who undergo treatment with curative intent. Non-white race, older age, and T4a disease are associated with worse 3-year OS in patients with HNSCC treated with upfront surgery. Patient Consent Statement: The patient presented in this video submission gave full consent to be recorded and for his video to be used for publication purposes. The authors have no disclosures to report. The authors have no commercial associations during the past 3 years or beyond that might create a conflict of interest in connection with this video. Source of Work: This study was approved by the Washington DC Veterans Affairs Medical Center IRB protocol No. 01783. There are no conflicts of interest or obligations resulting from this study. The authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. Runtime of video: 4 mins 32 secs