Radical neck dissection: is it still indicated?

Abstract

The presence of lymph node metastases in the neck remains a significant prognostic factor affecting patients with head and neck squamous cell carcinoma (HNSCC). Thus, treatment of regional disease remains a critical issue in the management of many patients. The ‘‘classical’’ radical neck dissection (RND), consisting of removal of all the lymphatic and non-lymphatic structures from the mandible to the clavicle, with the exception of the carotid artery, hypoglossal, lingual, vagus and phrenic nerves, and brachial plexus, was developed in the late nineteenth and early twentieth century [1‐4]. The procedure did not achieve widespread use in the medical community until the work of Martin et al. [5] when midcentury advances such as antibiotics, blood transfusion and modern anesthesia permitted safe and efficacious operation in a large series of patients. The classic RND has been and is still considered the ‘‘gold standard’’ for the surgical management of lymph node metastases of cancers of the head and neck.