Neck Dissection Following Concurrent Chemoradiation for Advanced Head and Neck Carcinoma: Pathologic Findings and Complications

Objective: To assess the rate of pathologic residual neck disease and complication rates following selective neck dissection in patients with advanced head and neck carcinoma after concurrent chemotherapy (CT) and radiation therapy (RT). Patients and Methods: Two hundred sixty-four patients with advanced-stage head and neck carcinoma underwent concurrent CT and RT from 1998 to 2004 at Notre-Dame Hospital. We describe the outcome of 32 of these patients who underwent neck dissections at our institution. The median age was 56 years (35-73 years). The primary sites were the oropharynx (n = 25), followed by the larynx (n = 3), hypopharynx (n = 1), and oral cavity (n = 1), and there were two unknown primary sites. The initial neck stages were 2 N1, 19 N2, and 11 N3. The known primary sites were staged 2 T1, 10 T2, 8 T3, 10 T4, and 2 Tx. All patients received conventional RT to a dose of 70 Gy in 35 fractions concurrent with a platinum-based CT regimen Results: The median follow-upwas 20 months. The mean operative blood loss for neck dissections alonewas 170 mL (SD = 158.3mL), the mean operative time was 128 minutes (SD = 41.6 minutes), and the mean hospital stay was 3.6 days (SD = 1.7 days). There were no major surgical complications. Five minor complications were noted in four patients (12.5%). Twelve patients (38%) had pathologic evidence of persistent disease (1 of 2 N1, 7 of 19 N2, and 4 of 11 N3). Conclusions: Cervical neck dissection is a safe procedure following concurrent CT and RT and is still indicated if there is clinical or radiologic evidence of disease persistence in the neck. We experienced no major surgical complications and few minor complications. The pathologic residual rate was 38%.