In our institute, neck dissection (ND) is considered to be a part of multidisciplinary treatments involving surgery and concurrent chemoradiotherapy (TAR therapy). We have applied modified neck dissection as well as less extensive selective neck dissection to patients with head and neck squamous cell carcinoma, based on a definite policy. During 2004-2008, 45 NDs were performed in 41 patients (33 males and 8 females) at Kyushu Kosei Nenkin Hospital. We retrospectively analyzed the treatment results to validate the therapeutic efficacy of our organ-preserving and less-extensive surgical policy. Classical radical neck dissection was performed in only 4 cases. In 36 (80%) cases, at least two of the spinal accessory nerve, the sternocleidomastoid muscle and the internal jugular were spared, while in 19 (42.2%) cases all three organs were preserved. SND was administered for 31 cases omitting 40% and 48% of the respective level I and V in laryngeal and pharyngeal cancer; 31.6%, 57.9% and 73.7% of the respective level III, IV and V in oral cancer. Among these 31 cases, 24 (66.7%) NDs were carried out as a therapeutic selective neck dissection (TSND) for N+ neck. Lymph node recurrence was observed in only 4 cases (8.9%). The cumulative regional control rate with SND and comprehensive ND were 93.6% and 83.6%, respectively. For N+ cases, 91.7% of the regional control rate was obtained in TSND, while 82.5% was obtained in comprehensive ND. These favorable results indicate that in the multimodality treatment setting, organ-preserving and less-extensive ND are appropriate treatment choices with respect to both QOL and oncological results.
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