The impact of patterns of nodal metastasis on modifications of neck dissection

Background: Radical neck dissection (RND) is standard treatment for cervical metastasis from head and neck cancer. Although effective, RND produces significant morbidity. In an effort to reduce this morbidity, modifications of RND have been developed. These modifications can be comprehensive yet spare some or all of the nonlymphatic structures removed in RND, or they can remove less than all the lymph node groups removed in RND and are termed selective neck dissections. We have reviewed the literature regarding the patterns of nodal metastasis from head and neck cancer to define the indications for these modifications of RND. Methods: A review of the literature concerning patterns of nodal metastasis from head and neck cancer was performed. Using this information, recommendations on the use of modifications of neck dissection were formulated. Results: In squamous cancers, with clinically negative neck supraomohyoid neck dissection is an adequate node sampling procedure for oral cavity and oropharyngeal lesions, and lateral (jugular) neck dissection for primary lesions of the hypopharynx, and larynx. In the clinically positive neck comprehensive neck dissection with preservation of the spinal accessory nerve is oncologically sound. Conclusions: Nodal metastasis of head and neck cancer occurs in predictable patterns. Based on these patterns of nodal metastasis, recommendations for the use of modifications of neck dissection are presented.