What is neck dissection?

Updated: Aug 19, 2020
  • Author: Ron Mitzner, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Cancers in the head and neck region commonly metastasize to cervical lymph nodes. The term "neck dissection" refers to a surgical procedure in which the fibrofatty contents of the neck are removed for the treatment of cervical lymphatic metastases. Neck dissection is most commonly used in the management of cancers of the upper aerodigestive tract. It is also used for malignancies of the skin of the head and neck area, the thyroid, and the salivary glands as depicted in the images below. [1]

Selective neck dissection levels I-III. Selective neck dissection levels I-III.
Selective neck dissection levels II-IV. Selective neck dissection levels II-IV.
Selective neck dissection for thyroid cancer: sele Selective neck dissection for thyroid cancer: selective neck dissection VI, or anterior neck dissection.
Selective neck dissection for posterior scalp and Selective neck dissection for posterior scalp and upper posterolateral neck cutaneous malignancies: selective neck dissection II-V, postauricular, suboccipital, or posterolateral neck dissection.
The 6 levels of the neck with sublevels. The 6 levels of the neck with sublevels.

Radical neck dissection was the original surgical procedure described for treatment of metastatic neck cancer. Crile described the operation in 1906, and until recently, radical neck dissection was considered the standard procedure for management of both occult and clinically positive neck disease. In the last 2 decades, a shift toward the use of more conservative surgical procedures has occurred. This shift is predicated upon the following 2 important insights that developed over a period of time: 1) the removal of lymphatic tissue is not hindered by preserving adjacent nonlymphatic structures; and 2) the specific nodal groups at risk for metastatic disease are predictable on the basis of the size, location, and other features of the primary tumor

Neck dissection with conservation of nonlymphatic structures was shown by Bocca, Gavilan, and others to yield equivalent oncologic outcomes, with improved functional results. [2, 3] Experimental studies of lymphatic drainage, coupled with clinical studies of the specific location of nodal metastasis within neck dissection specimens, provided the rationale for more targeted surgery. [4, 5, 6] The data allowed for reliable prediction of the lymph node groups most likely to be involved with metastatic disease from specific primary tumor location and established which lymph node groups carry negligible risk of involvement and may be safely preserved. As a result, a great variety of surgical procedures have been described for use in various clinical situations.

In order to bring uniformity to the terminology used to describe these operations, the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) sponsored the Committee for Head and Neck Surgery and Oncology to develop a classification system for neck dissections. In 1991, the committee published the first classification schema. This schema, later modified in 2002 and 2008, has become universally accepted and is currently endorsed by both the AAO-HNS and the American Society for Head and Neck Surgery. [7, 8, 9, 10, 11]

A retrospective study by van Lanschot et al indicated that in patients with early stage oral cavity squamous cell carcinoma, 5-year regional recurrence–free survival (RRFS) rates are lower in patients with depth of invasion of 4 mm or more who are not treated with elective neck dissection. Those treated with elective neck dissection had an RRFS rate of 89.0%, compared with 69.9% for those who did not undergo dissection. [12]


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