The role of elective neck dissection during surgical salvage for recurrent nasopharyngeal carcinoma

Abstract

Background:To study the incidence of microscopic tumour deposit in the neck in patients with recurrent nasopharyngeal carcinoma (NPC) and hence, the role of routine elective neck dissection during nasopharyngectomy. Methods:Retrospective review of the pathology report of the selective neck dissection specimens in patients with recurrent NPC and clinically N0 status. Results:Between 2000 and 2012, 38 patients presented with recurrent NPC requiring maxillary swing nasopharyngectomy and free flap reconstruction. The initial T-classification of the tumour was T1, 15.8%; T2, 52.6%; and T3, 31.6%, and the N-classification was N0, 26.3%; N1, 47.4%, N2, 15.8%; and N3, 10.5%. Concurrent chemoradiation was given in 57.9% of the subjects. All patients in the series had complete response after the initial treatment, and the mean time to develop local tumour recurrence was 22.3 months. Among these patients, only 1 (2.6%) demonstrated microscopic tumour metastasis in 1 lymph node removed during selective neck dissection. Conclusions: Given the low incidence of microscopic tumour metastasis in patients with recurrent NPC and clinically N0 status, routine elective neck dissection is not indicated.