Biomaterial Database

The role of comprehensive neck dissection with preservation of the spinal accessory nerve in the clinically positive neck. 1994

P E Andersen, and J P Shah, and E Cambronero, and R H Spiro

Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10021.

BACKGROUND The most significant prognostic factor in patients with squamous cell carcinoma of the head and neck is the presence of cervical nodal metastases. Radical neck dissection is the standard by which all cervical lymphadenectomy procedures are judged. In the presence of clinically positive nodal metastasis, the benefit of preserving the spinal accessory nerve (SAN) has to be weighed against the possible risk of increased failure in the neck. We performed this retrospective study to determine if preservation of the SAN in patients with clinically evident nodal metastases was associated with increased risk of failure in the dissected neck. METHODS Between January 1, 1984 and December 31, 1991, 378 comprehensive neck dissections were performed in 366 patients with clinically and pathologically positive nodal metastases from squamous carcinoma of the upper aerodigestive tract. We compared survival, neck control rates, and other factors in patients who had a classic radical neck dissection (RND) to those who had modified radical neck dissection sparing only the SAN (MRND I). RESULTS Actuarial 5-year survival and neck failure rates for the RND group were 63% and 12%, compared to 71% and 8% for the MRND I group (P = NS). Survival and neck failure were not statistically different between the MRND I and RND groups when the analysis controlled for pathologic N stage, presence of extra capsular spread, and the presence of pathologically demonstrated metastatic nodes along the course of the SAN. Nor were there significantly different patterns of neck failure with RND versus MRND. CONCLUSIONS Modification RND to preserve an uninvolved SAN in the clinically positive neck does not adversely affect survival or neck control.

UI	MeSH Term	Description	Entries
D008207	Lymphatic Metastasis	Transfer of a neoplasm from its primary site to lymph nodes or to distant parts of the body by way of the lymphatic system.	Lymph Node Metastasis,Lymph Node Metastases,Lymphatic Metastases,Metastasis, Lymph Node
D008297	Male		Males
D008875	Middle Aged	An adult aged 45 - 64 years.	Middle Age
D002294	Carcinoma, Squamous Cell	A carcinoma derived from stratified SQUAMOUS EPITHELIAL CELLS. It may also occur in sites where glandular or columnar epithelium is normally present. (From Stedman, 25th ed)	Carcinoma, Epidermoid,Carcinoma, Planocellular,Carcinoma, Squamous,Squamous Cell Carcinoma,Carcinomas, Epidermoid,Carcinomas, Planocellular,Carcinomas, Squamous,Carcinomas, Squamous Cell,Epidermoid Carcinoma,Epidermoid Carcinomas,Planocellular Carcinoma,Planocellular Carcinomas,Squamous Carcinoma,Squamous Carcinomas,Squamous Cell Carcinomas
D005260	Female		Females
D006258	Head and Neck Neoplasms	Soft tissue tumors or cancer arising from the mucosal surfaces of the LIP; oral cavity; PHARYNX; LARYNX; and cervical esophagus. Other sites included are the NOSE and PARANASAL SINUSES; SALIVARY GLANDS; THYROID GLAND and PARATHYROID GLANDS; and MELANOMA and non-melanoma skin cancers of the head and neck. (from Holland et al., Cancer Medicine, 4th ed, p1651)	Cancer of Head and Neck,Head Cancer,Head Neoplasm,Head and Neck Cancer,Head and Neck Neoplasm,Neck Cancer,Neck Neoplasm,Neck Neoplasms,Neoplasms, Upper Aerodigestive Tract,UADT Neoplasm,Upper Aerodigestive Tract Neoplasm,Upper Aerodigestive Tract Neoplasms,Cancer of Head,Cancer of Neck,Cancer of the Head,Cancer of the Head and Neck,Cancer of the Neck,Head Neoplasms,Head, Neck Neoplasms,Neoplasms, Head,Neoplasms, Head and Neck,Neoplasms, Neck,UADT Neoplasms,Cancer, Head,Cancer, Neck,Cancers, Head,Cancers, Neck,Head Cancers,Neck Cancers,Neoplasm, Head,Neoplasm, Neck,Neoplasm, UADT,Neoplasms, UADT
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000055	Accessory Nerve	The 11th cranial nerve which originates from NEURONS in the MEDULLA and in the CERVICAL SPINAL CORD. It has a cranial root, which joins the VAGUS NERVE (10th cranial) and sends motor fibers to the muscles of the LARYNX, and a spinal root, which sends motor fibers to the TRAPEZIUS and the sternocleidomastoid muscles.	Cranial Nerve XI,Eleventh Cranial Nerve,Spinal Accessory Nerve,Nerve XI,Nervus Accessorius,Accessorius, Nervus,Accessory Nerve, Spinal,Accessory Nerves,Accessory Nerves, Spinal,Cranial Nerve, Eleventh,Cranial Nerves, Eleventh,Eleventh Cranial Nerves,Nerve XIs,Nerve, Accessory,Nerve, Eleventh Cranial,Nerve, Spinal Accessory,Nerves, Accessory,Nerves, Eleventh Cranial,Nerves, Spinal Accessory,Spinal Accessory Nerves
D000368	Aged	A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available.	Elderly
D012189	Retrospective Studies	Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.	Retrospective Study,Studies, Retrospective,Study, Retrospective