A selective approach to neck dissection for mucosal squamous cell carcinoma.

A personal series of 189 neck dissections performed over 6 years among 154 patients with mucosal squamous cell carcinoma is presented. The most common primary sites were the oral cavity (66), oropharynx (38) and hypopharynx (17). There were 104 therapeutic and 85 elective neck dissections. Over 40% of therapeutic dissections were modified or selective procedures. Radical neck dissection was never used electively. Seventy-eight patients (50%) had postoperative radiotherapy to the neck. Nodes were histologically positive in 110 dissections overall (58%); 92% of therapeutic dissections and 17% of elective dissections. Extracapsular spread was present in 65% of positive dissections. Ipsilateral neck recurrence developed in 10 of 60 patients who had therapeutic radical dissections (17%) and in 2 of 44 patients who had therapeutic, modified or selective dissections (5%). Recurrence after elective dissection occurred in only one patient (1.2%). It is concluded that modified and selective neck dissection are safe and oncologically effective when used among selected patients and combined with adjuvant radiotherapy. Neck recurrence may still occur among patients with advanced and biologically aggressive disease despite radical therapy.