Neck dissection after radiochemotherapy for head-neck cancer

For patients with cancer of the upper airways and food canal, the demonstration of lymphogenic metastases is the most important prognostic factor for survival, which is significantly reduced depending on the number of regional lymph node metastases. Thus, the treatment of regional lymph flow ( neck dissection) is a primary surgical procedure among the therapeutic options. For multimodal therapy concepts this is also true for radiochemotherapy. Various problems can be determined from literature based data: the studies use different radiochemotherapeutic protocols as well as various times between radiochemotherapy and neck dissection. Indications for neck dissection remain unclear as do those for the extent of the dissection. Published data provide only partial or no statements on N-status, tumor localization, stage distribution, etc. In addition, only incomplete information on the correlation between pre- and postoperative neck status as well as imaging diagnostics and postoperative histologically verified results is available. When considering the histopathological results, standards are lacking, and the question of when a cell is neither apoptotic nor necrotic but is still capable of proliferation and metastasis is not clearly answered.