Surgical treatment of cervical node metastases from squamous carcinoma of the upper aerodigestive tract: evaluation of the evidence for modifications of neck dissection.

Abstract

This review article examines the role of the different types of neck dissection in the treatment of squamous carcinoma metastases to the cervical nodes. A critical evaluation of the literature on the pathologic basis, oncologic effectiveness, and functional outcome of neck dissection. Pathologic data show preferential metastasis to different lymph node levels, in N0- and N+-staged disease, depending on the primary tumor site. Comparative studies on control of regional metastases suggest that modified radical is no less effective than radical neck dissection, but there is insufficient data to draw firm conclusions on the role of selective neck dissection. Selective and modified radical dissections result in less shoulder disability than radical neck dissection. Modified radical neck dissection is supported by pathologic and clinical evidence in N1- and 2-staged disease. There may be a role for selective dissection, but there is a need for more information on oncologic outcome. Prospective multicenter systematic data collection on the outcome of neck dissection is a pragmatic alternative to a trial.