From the Guidelines
A neck dissection, also known as a cervical lymph node dissection, is a surgical procedure that removes lymph nodes in the neck to treat or prevent the spread of cancer.
Types of Neck Dissections
- Comprehensive neck dissection: removes all lymph node groups in the neck, including those in levels I through VI, and may involve the removal of additional structures such as the sternocleidomastoid muscle, jugular vein, or spinal accessory nerve 1.
- Selective neck dissection: removes only specific lymph node groups in the neck, depending on the location and extent of the cancer, and is often used for patients with early-stage cancer or those who are at low risk for lymph node metastasis 1.
Indications for Neck Dissection
Neck dissection is typically performed for patients with head and neck cancers, including those with oral, oropharyngeal, hypopharyngeal, or laryngeal cancers, and may be elective or therapeutic 1.
Determining the Extent of Neck Dissection
The extent of neck dissection is determined by the surgeon based on the preoperative clinical staging and the location and extent of the cancer, with comprehensive neck dissections often recommended for patients with advanced disease (N3) and selective neck dissections recommended for patients with early-stage disease (N0) 1.
Levels of Neck Dissection
The levels of neck dissection are defined as follows:
| Level | Description |
|---|---|
| I | Submandibular and submental lymph nodes |
| II-IV | Jugular lymph nodes |
| V | Posterior triangle lymph nodes |
| VI | Anterior compartment lymph nodes, including those in the pretracheal and paratracheal regions |
| The specific levels of neck dissection performed depend on the location and extent of the cancer, as well as the surgeon's discretion [1]. |
From the Research
Definition and Purpose of Neck Dissection
- Neck dissection, also known as cervical lymph node dissection, is a surgical procedure used to diagnose and treat head and neck cancer by removing lymph nodes in the neck 2, 3, 4, 5, 6.
- The primary goal of neck dissection is to remove cancerous lymph nodes and prevent the spread of cancer to other parts of the body 2, 3.
Types of Neck Dissection
- Radical neck dissection is considered the "gold standard" for surgical management of lymph node metastases in head and neck squamous cell carcinoma (HNSCC) 2.
- Selective neck dissection is used in selected patients and is a more limited procedure than radical neck dissection 2, 3.
- Sentinel lymph node biopsy is a diagnostic procedure used to stage the neck in node-negative early oral cavity squamous cell carcinoma 2.
Indications and Extent of Neck Dissection
- The extent of neck dissection depends on the primary tumor location and T and N stage 3.
- Neck dissection is essential for patients with clinically residual disease in the neck 2, 3.
- The procedure is also used to treat cervical lymph node metastases in head and neck cancer 5.