Functional Neck Dissection for the Clinically Negative Neck: Effectiveness and Controversies

Abstract

This study was performed to evaluate the effectiveness of functional neck dissection in controlling metastasis to the clinically negative (cNO) neck, focusing on recurrences in the pathologically negative (pNO) neck and the role of extracapsular spread in the cNO neck. A series of 172 patients (253 dissected fields) treated for cNO laryngeal or hypopharyngeal cancer with a 5-year minimum follow-up is presented. Occult metastasis was observed in 30% of the patients. Extracapsular spread was present in 39% of the positive nodes. The neck recurrence rate was 5.2%. Surgical specimens from cases of neck recurrence in pNO necks were reevaluated for micrometastasis by immunostaining with antibody for cytokeratins. The immunohistochemical findings were positive in 1 of 4 cases. Functional neck dissection provides good neck control and survival rates for the cNO neck. The accurate prognostic significance of extracapsular spread in cNO necks is still unknown. Micrometastasis alone may be insufficient to explain recurrences in pNO necks.