Significance of Modified Radical Neck Dissection Type III in Node-Positive Neck in Patients with Head and Neck Squamous Cell Carcinoma

Tae, Kyung; Lee, Keun Young; Shin, Kwang Su; Lee, Yong Seop; Park, Chul Won; Lee, Hyung Seok

Abstract

BACKGROUND AND OBJECTIVES: The most significant prognostic factor in patients with squamous cell carcinoma of the head and neck is the presence of cervical nodal metastases. Until 1960s, radical neck dissection (RND) was the standard surgical treatment of the cervical lymphatic nodes. However, with increasing recognition of the substantial morbidity of radical surgery, more emphasis is being placed on surgical conservatism if it does not negatively impact disease control and if it offers improved postoperative function and cosmesis. We performed this retrospective study to evaluate the oncologic and functional efficacy of a modified radical neck dissection type III (MRND type III) that spares the spinal accessory nerve (SAN), internal jugular vein (IJV) and sternocleidomastoid (SCM) muscle in patients with pathologically node-positive squamous cell carcinoma of the head and neck.
SUBJECTS AND METHOD
We studied retrospectively the results of 66 comprehensive neck dissections performed on 61 patients with pathologically positive nodal metastases from squamous cell carcinoma of the head and neck between August, 1995 and January, 2005. We analyzed the regional recurrence rates, the patency of the preserved IJV and the cross sectional area of the SCM muscle in patients who had a MRND type III.
RESULTS
Regional recurrence rates [RND or extended RND (ERND) group: 18.2%; MRND type I or II group: 21.4%; MRND type III group: 15.9%] were not statistically different between the MRND type III and other comprehensive neck dissection groups (p=NS). After the MRND type II or III, IJV were significantly narrowed in 5 patients (10.9%), the overall blood flow was still intact. There was no evidence of the intraluminal thrombosis in this study. The cross-sectional area of the preserved SCM muscles (n=44) was reduced by 12.7% (+/-9.6%). But, no patient showed significant morphological change and functional disability of the SCM muscle.
CONCLUSION
The MRND type III in the pathologically node-positive neck does not adversely affect neck control. Despite some narrowing of IJVs and atrophic change of SCM muscles after MRND type III, they reported satisfactory functional and cosmetic outcomes.