What are the different types of neck lymph node dissections?

From the Guidelines

Neck lymph node dissections can be broadly classified into comprehensive and selective dissections, with the choice of procedure depending on the primary cancer's location, extent, and histology, as well as whether the procedure is being done for treatment or staging purposes. The main types of neck lymph node dissections include:

• Comprehensive neck dissection, which removes all lymph node groups that would be included in a classic radical neck dissection, regardless of whether the sternocleidomastoid muscle, jugular vein, or spinal accessory nerve is preserved 1
• Selective neck dissection, which targets specific lymph node groups based on the primary tumor's location and likely drainage patterns, with subtypes including supraomohyoid (levels I-III), lateral (levels II-IV), posterolateral (levels II-V), and anterior compartment (level VI) dissections 1
• Radical neck dissection, which is the most extensive, removing all lymph node groups from levels I-V along with the sternocleidomastoid muscle, internal jugular vein, and spinal accessory nerve
• Modified radical neck dissection, which preserves one or more of these non-lymphatic structures while still removing all lymph node groups
• Extended neck dissection, which goes beyond the boundaries of radical dissection to remove additional lymph node groups or structures

The decision to perform a comprehensive or selective neck dissection depends on the clinical staging of the patient, with comprehensive neck dissection often recommended for N3 disease and selective neck dissection recommended for N0 disease 1. The type of dissection performed also depends on the primary tumor site, with elective level VI dissections often considered appropriate for infraglottic laryngeal cancers 1.

In general, the choice of neck dissection type should be based on the risk of occult metastasis in the appropriate nodal basin, as well as the need to balance oncologic control with functional and cosmetic outcomes 1.

Some key points to consider when deciding on the type of neck dissection to perform include:

• The primary tumor site and its likely drainage patterns
• The clinical staging of the patient, including the presence or absence of nodal disease
• The need to balance oncologic control with functional and cosmetic outcomes
• The potential for elective neck dissection to prevent morbidity in patients with nodal disease

Overall, the choice of neck lymph node dissection type should be individualized based on the specific clinical scenario, taking into account the primary tumor site, extent, and histology, as well as the patient's overall health status and treatment goals 1.

From the Research

Types of Neck Lymph Node Dissections

The different types of neck lymph node dissections include:

• Radical neck dissection: involves the removal of all lymph nodes on one side of the neck, along with the sternocleidomastoid muscle, the omohyoid muscle, and the internal jugular vein 2
• Modified radical neck dissection: involves the removal of all lymph nodes on one side of the neck, but preserves the sternocleidomastoid muscle, the omohyoid muscle, and the internal jugular vein 2, 3
• Selective neck dissection: involves the removal of only the lymph nodes in specific areas of the neck, depending on the location and extent of the cancer 2, 4, 5, 6
• Superselective neck dissection: involves the removal of only the lymph nodes in levels II-III of the neck 5
• Prophylactic central neck dissection (pCND): involves the removal of lymph nodes in the central compartment of the neck, even if there is no evidence of cancer in this area 4
• Therapeutic central neck dissection (tCND): involves the removal of lymph nodes in the central compartment of the neck, when there is evidence of cancer in this area 4
• Prophylactic lateral neck dissection (LND): involves the removal of lymph nodes in the lateral compartment of the neck, even if there is no evidence of cancer in this area 4
• Therapeutic lateral neck dissection (tLND): involves the removal of lymph nodes in the lateral compartment of the neck, when there is evidence of cancer in this area 4, 6

Indications for Each Type of Dissection

The choice of neck dissection type depends on the location and extent of the cancer, as well as the patient's overall health and preferences. For example:

• Radical neck dissection is often used for advanced cancers that have spread to multiple lymph nodes in the neck 2
• Modified radical neck dissection is often used for cancers that have spread to lymph nodes in the neck, but are still relatively localized 3
• Selective neck dissection is often used for early-stage cancers that have not spread to multiple lymph nodes in the neck 2, 4, 5, 6
• Superselective neck dissection is often used for cancers that have spread to lymph nodes in levels II-III of the neck, but not to other areas of the neck 5
• Prophylactic central neck dissection is often used for patients with differentiated thyroid cancer, to remove lymph nodes in the central compartment of the neck that may contain cancer cells 4
• Therapeutic central neck dissection is often used for patients with differentiated thyroid cancer, to remove lymph nodes in the central compartment of the neck that contain cancer cells 4
• Prophylactic lateral neck dissection is not recommended for patients with differentiated thyroid cancer, as it can increase the risk of complications without improving outcomes 4
• Therapeutic lateral neck dissection is often used for patients with differentiated thyroid cancer, to remove lymph nodes in the lateral compartment of the neck that contain cancer cells 4, 6