The role of neck dissection in head and neck mucosal squamous cancer

Neck dissection for squamous cell carcinoma of the head and neck

OBJECTIVES

To investigate the successes and failures of 172 patients receiving neck dissections for squamous cell carcinoma (SCC) managed through a multidisciplinary head and neck clinic and to observe factors in predicting failure (death with head and neck cancer or local regional recurrence) or local regional recurrence alone.

STUDY DESIGN

A retrospective, 14-year surgical audit.

METHODS

The information from patient medical records was correlated with that of a database. Multivariate analysis was performed with the use of a logistic regression model.

RESULTS

The most common site for head and neck SCC was the oral cavity (42%), with 17% of patients having tumors of unknown primary site. The disease-free survival probability was 76.7% at five years. Patients who were older at neck dissection, were nonsmokers, or who did not have radiotherapy to the primary site were more likely to die with head and neck cancer or to have local regional recurrence (P < 0.1). Patients with more radical neck dissections did not have better survival or recurrence outcomes. Lymphatic invasion appears to be the only important factor in predicting local regional recurrence alone (P = 0.1), of which 67% occurred within the first postoperative year.

CONCLUSIONS

Patients with smoking-related SCC are likely to have a less aggressive disease. Adjuvant radiotherapy plays an important role in the treatment of patients with head and neck SCC. Follow-up, especially within the first postoperative year, is essential in managing head and neck SCC. Head and neck surgeons can confidently continue their practice away from more radical neck dissections.

Neck dissection and the clinical appearance of post-operative shoulder disability: the post-operative role of physiotherapy

This paper critically reviews the literature, describing a post-operative phenomenon which is traditionally seen by physiotherapists in the immediate inpatient setting, following neck dissection (ND) for head and neck cancer. The presence and incidence of this condition is explored and the potential impact on the surviving patient's quality of life is considered. The nature and development of shoulder disability following ND is investigated and proposed roles of key anatomical structures involved are considered with relation to pathodynamics. A model for understanding the assessment and holistic management of this condition is offered and the potential implications for physiotherapy practice in primary care are considered.