Elective Neck Dissection in Head and Neck Cancer

Abstract

SINCE 1906, when Crile first advocated wide en bloc excision of the cervical lymphatic tissues and their surrounding nonessential structures as a fundamental feature in the treatment of epithelial malignancies of the head and neck, controversy has evolved regarding the indications for and staging of the elective neck dissection. It is recognized that the presence of metastases in the cervical lymph nodes significantly alters the long-term survival rate following surgical assault on head and neck tumors. Little doubt remains that neck dissection is presently the most promising therapeutic measure in the management of regional metastases to the cervical lymph nodes. Considerable doubt does exist with regard to the most propitious moment of initiating the procedure, whether it should be performed in continuity with the resection of the primary lesion, or whether it may justifiably be deferred until palpable cervical adenopathy develops. The definitive solution to this problem may appear as