Selective Neck Dissection of Anatomically Appropriate Levels Is as Efficacious as Modified Radical Neck Dissection for Elective Treatment of the Clinically Negative Neck in Patients With Squamous Cell Carcinoma of the Upper Respiratory and Digestive Tracts

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Abstract
Patients with primary squamous cell carcinomas of the upper respiratory and digestive tracts with a greater than 20% probability of occult cervical metastases but with nodes clinically negative for metastatic disease warrant elective treatment of the neck for prognostic, diagnostic, and therapeutic purposes.1 (Throughout this article, "negative" and "positive" indicate the absence or presence, respectively, of metastatic disease.) Such treatment may be surgical (ie, modified radical or selective neck dissection). Although the optimal treatment strategy is controversial, it is generally agreed that the outcome is better after dissection of histologically positive nodes in necks with clinically negative nodes than it is when a watch-and-wait policy is adopted in which the lymph nodes are dissected only after clinical adenopathy develops.2,3 Selective neck dissection, which includes dissection of only the lymph nodes at risk, may be associated with less patient morbidity than the modified radical technique. Removal of those lymph nodes at risk of metastases is the cornerstone of selective procedures. It remains controversial whether selective neck dissection of anatomically appropriate levels is as effective as modified radical neck dissection for elective treatment of the clinically negative neck in patients with squamous cell carcinoma of the upper respiratory and digestive tracts. After a brief review of pertinent background material, the focus of the following discussion will be to present relevant data and arguments for and against the therapeutic equivalence of selective and modified radical neck dissection in the management of the clinically negative neck.