How is selective neck dissection defined?

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

This term refers to a type of neck dissection in which one or more lymph node groups normally removed in a radical neck dissection are preserved. The 1991 classification schema classified selective neck dissections into the following categories: supraomohyoid neck dissection (levels I, II, III), lateral neck dissection (levels II, III, IV), anterior compartment neck dissection (VI), and posterolateral neck dissection (levels II, III, IV, V). Because of the increased use of selective neck dissection and the increased selectivity with which lymph node groups are removed, the Committee for Head and Neck Surgery and Oncology revised the classification of selective neck dissections in 2002.

Because the 1991 classification did not provide an accurate description of procedures in which the surgeon preserves certain sublevels, the 2002 classification excludes the above listed "named" selective neck dissections. In the 2002 classification, selective neck dissections are described with respect to the lymph node levels removed. For example, a supraomohyoid neck dissection is described as a selective neck dissection (I-III).

A retrospective study by Barzan et al indicated that selective neck dissection can be safely and effectively performed as primary and salvage surgery. The report involved 827 patients with primary head and neck tumors who underwent the selective operation, with just 22 of 40 neck cancer recurrences later arising on the dissected side of the neck. The incidence of recurrence was approximately the same after primary and salvage surgery (4.4% and 5.2%, respectively). [17]


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