The estimation of oncological value of selective neck dissection in cervicofacial region tumors

Abstract

There has recently been one hundred years since George Crile demonstrated systematic cervical lymph nodes excision for treatment of patients with head and neck cancer. Due to morbidity of the radical surgical approach, the emphasis was made on surgically conservative approach, in cases where it does not have adverse effects on disease control and still offers preservation of functional and cosmetic status. Modified radical neck dissection (MRND) removes "en block" the same lymph nodes and vessels as radical dissection, but by preserving one or more non-lymphatic structures that are being entirely removed by radical dissection, it decreases postoperative morbidity. Selective neck dissections, which are being preferred by American head and neck surgeons, went even further. The research was performed at Institute for Otolaryngology and Maxillofacial Surgery of Clinical Center of Serbia in Belgrade. The study included 319 patients treated period, from January 1, 1997 to December 31, 2001, who have been followed up for at least 5 years after treatment. Having in mind that this was retrospective clinical study, i.e. longitudinal study, the choice of patients and variables was made based on patient records. Of 302 patients with determined category, the most were in T2 category (40.44%), while T1 tumors were four times less frequent. It has been observed that metastases recurrences have occurred in 57/319 (17.86%) subjects at various time intervals. By analyzing recurrent metastases according to N categories, it has been determined that the most of them were in N1 and N2 category. This was expected, as N1 category was the most represented in the entire group of patients with 137/319 (42.94%) cases, and the largest number of neck dissections - 137/291 (47.08%), primarily SND, were performed within this category. Patient five-year survival in our study has been analyzed according to N category, type of neck dissection, and recurrence of metastases (Figure 2). Over the first two years of follow-up, there has been larger survival tendency in MRND group compared to SND. The difference became comparable in the third year, and increased in favor of SND by the end of follow-up period. Although arithmetic mean value was almost the same, and median value was higher in patients with MRND, there is no significant difference in five-year survival among patients with N1 category (0.43; df=1; p>0.05).