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Article: Neck dissection: Then and now

TitleNeck dissection: Then and now
Authors
KeywordsFunctional neck dissection
Neck dissection
Radical neck dissection
Selective neck dissection
Superselective neck dissection
Issue Date2006
PublisherElsevier BV. The Journal's web site is located at http://www.elsevier.com/locate/anl
Citation
Auris Nasus Larynx, 2006, v. 33 n. 4, p. 365-374 How to Cite?
AbstractThe significance of metastatic disease in the lymph nodes of the neck as a critical independent prognostic factor in head and neck cancer has long been appreciated. Although 19th century surgeons attempted to remove involved cervical lymph nodes at the time of resection of the primary cancer, a systematic approach to en bloc removal of cervical lymph node disease, described in detail by Jawdyński in 1888 and popularized and illustrated by Crile in the early 20th century, provided consistent and more effective treatment, and forms the basis of our current techniques. During the first half of the 20th century, developments included preservation of the accessory nerve in selected cases, elective neck dissection performed in association with resection of various primary tumors, bilateral neck dissection and limited neck dissection. The greatest impetus to the status of radical neck dissection came from Martin, whose technique consisted of resection of all lymph nodes from level I-V together with the accessory nerve, internal jugular vein, sternocleidomastoid muscle and various other structures in a single block of resected tissue. Martin's technical precepts were followed until the latter part of the 20th century when modifications in technique began to find general acceptance. The first description of an effective technique of modified radical neck dissection was published in Spanish by Suárez, in 1963. This technique, which preserves important structures, such as the internal jugular vein, sternocleidomastoid muscle and accessory nerve, was refined and popularized by various authors who published their results in the English language literature during the period from 1964 through 1990 and beyond. Modified or "functional" neck dissection avoids much of the morbidity of radical neck dissection while achieving equivalent degrees of control of regional disease in properly selected cases. By the late 20th century, the concept of selective neck dissection, consisting of resection of only the nodal groups at greatest risk for metastasis from a given primary site, was studied and developed. These limited dissections are now widely employed for elective, and in properly selected cases, therapeutic treatment and staging of the neck, and have been proposed for limited cervical recurrences after various chemoradiation protocols. Prospective studies have demonstrated similar rates of neck recurrence and survival after elective selective neck dissection compared to elective modified radical neck dissection. Other modifications and factors applied to treatment of cervical lymph node disease include the use of adjuvant and neo-adjuvant radiation and chemotherapy, a revised system for classification of neck dissections, the identification of various adverse prognostic factors such as extracapsular spread and extranodal soft tissue deposits, application of sentinel lymph node biopsy to staging of the neck, the use of immunohistochemical and molecular techniques for identification of lymph node metastases not detectable by light microscopy, and the possibility of endoscopic neck dissection. The authors conclude that neck dissection, as evolved over the past century, is a fundamental tool in management of patients with head and neck cancer, but is still a work in progress. © 2006 Elsevier Ireland Ltd. All rights reserved.
Persistent Identifierhttp://hdl.handle.net/10722/84573
ISSN
2015 Impact Factor: 1.038
2015 SCImago Journal Rankings: 0.688
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorFerlito, Aen_HK
dc.contributor.authorRinaldo, Aen_HK
dc.contributor.authorSilver, CEen_HK
dc.contributor.authorShah, JPen_HK
dc.contributor.authorSuárez, Cen_HK
dc.contributor.authorMedina, JEen_HK
dc.contributor.authorKowalski, LPen_HK
dc.contributor.authorJohnson, JTen_HK
dc.contributor.authorStrome, Men_HK
dc.contributor.authorRodrigo, JPen_HK
dc.contributor.authorWerner, JAen_HK
dc.contributor.authorTakes, RPen_HK
dc.contributor.authorTowpik, Een_HK
dc.contributor.authorRobbins, KTen_HK
dc.contributor.authorLeemans, CRen_HK
dc.contributor.authorHerranz, Jen_HK
dc.contributor.authorGavilán, Jen_HK
dc.contributor.authorShaha, ARen_HK
dc.contributor.authorWei, WIen_HK
dc.date.accessioned2010-09-06T08:54:32Z-
dc.date.available2010-09-06T08:54:32Z-
dc.date.issued2006en_HK
dc.identifier.citationAuris Nasus Larynx, 2006, v. 33 n. 4, p. 365-374en_HK
dc.identifier.issn0385-8146en_HK
dc.identifier.urihttp://hdl.handle.net/10722/84573-
dc.description.abstractThe significance of metastatic disease in the lymph nodes of the neck as a critical independent prognostic factor in head and neck cancer has long been appreciated. Although 19th century surgeons attempted to remove involved cervical lymph nodes at the time of resection of the primary cancer, a systematic approach to en bloc removal of cervical lymph node disease, described in detail by Jawdyński in 1888 and popularized and illustrated by Crile in the early 20th century, provided consistent and more effective treatment, and forms the basis of our current techniques. During the first half of the 20th century, developments included preservation of the accessory nerve in selected cases, elective neck dissection performed in association with resection of various primary tumors, bilateral neck dissection and limited neck dissection. The greatest impetus to the status of radical neck dissection came from Martin, whose technique consisted of resection of all lymph nodes from level I-V together with the accessory nerve, internal jugular vein, sternocleidomastoid muscle and various other structures in a single block of resected tissue. Martin's technical precepts were followed until the latter part of the 20th century when modifications in technique began to find general acceptance. The first description of an effective technique of modified radical neck dissection was published in Spanish by Suárez, in 1963. This technique, which preserves important structures, such as the internal jugular vein, sternocleidomastoid muscle and accessory nerve, was refined and popularized by various authors who published their results in the English language literature during the period from 1964 through 1990 and beyond. Modified or "functional" neck dissection avoids much of the morbidity of radical neck dissection while achieving equivalent degrees of control of regional disease in properly selected cases. By the late 20th century, the concept of selective neck dissection, consisting of resection of only the nodal groups at greatest risk for metastasis from a given primary site, was studied and developed. These limited dissections are now widely employed for elective, and in properly selected cases, therapeutic treatment and staging of the neck, and have been proposed for limited cervical recurrences after various chemoradiation protocols. Prospective studies have demonstrated similar rates of neck recurrence and survival after elective selective neck dissection compared to elective modified radical neck dissection. Other modifications and factors applied to treatment of cervical lymph node disease include the use of adjuvant and neo-adjuvant radiation and chemotherapy, a revised system for classification of neck dissections, the identification of various adverse prognostic factors such as extracapsular spread and extranodal soft tissue deposits, application of sentinel lymph node biopsy to staging of the neck, the use of immunohistochemical and molecular techniques for identification of lymph node metastases not detectable by light microscopy, and the possibility of endoscopic neck dissection. The authors conclude that neck dissection, as evolved over the past century, is a fundamental tool in management of patients with head and neck cancer, but is still a work in progress. © 2006 Elsevier Ireland Ltd. All rights reserved.en_HK
dc.languageengen_HK
dc.publisherElsevier BV. The Journal's web site is located at http://www.elsevier.com/locate/anlen_HK
dc.relation.ispartofAuris Nasus Larynxen_HK
dc.rightsAuris Nasus Larynx. Copyright © Elsevier BV.en_HK
dc.subjectFunctional neck dissectionen_HK
dc.subjectNeck dissectionen_HK
dc.subjectRadical neck dissectionen_HK
dc.subjectSelective neck dissectionen_HK
dc.subjectSuperselective neck dissectionen_HK
dc.titleNeck dissection: Then and nowen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0385-8146&volume=33&spage=365&epage=374&date=2006&atitle=Neck+dissection:+Then+and+nowen_HK
dc.identifier.emailWei, WI: hrmswwi@hku.hken_HK
dc.identifier.authorityWei, WI=rp00323en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.anl.2006.06.001en_HK
dc.identifier.pmid16889923-
dc.identifier.scopuseid_2-s2.0-33749426525en_HK
dc.identifier.hkuros124829en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-33749426525&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume33en_HK
dc.identifier.issue4en_HK
dc.identifier.spage365en_HK
dc.identifier.epage374en_HK
dc.identifier.isiWOS:000241642600001-
dc.publisher.placeNetherlandsen_HK
dc.identifier.scopusauthoridFerlito, A=7102481468en_HK
dc.identifier.scopusauthoridRinaldo, A=7103192494en_HK
dc.identifier.scopusauthoridSilver, CE=7006022958en_HK
dc.identifier.scopusauthoridShah, JP=7403266008en_HK
dc.identifier.scopusauthoridSuárez, C=34572724900en_HK
dc.identifier.scopusauthoridMedina, JE=7402370420en_HK
dc.identifier.scopusauthoridKowalski, LP=7102126040en_HK
dc.identifier.scopusauthoridJohnson, JT=7406810895en_HK
dc.identifier.scopusauthoridStrome, M=7005277118en_HK
dc.identifier.scopusauthoridRodrigo, JP=7103382101en_HK
dc.identifier.scopusauthoridWerner, JA=7403262883en_HK
dc.identifier.scopusauthoridTakes, RP=6603562251en_HK
dc.identifier.scopusauthoridTowpik, E=7004803881en_HK
dc.identifier.scopusauthoridRobbins, KT=7201662420en_HK
dc.identifier.scopusauthoridLeemans, CR=35444402300en_HK
dc.identifier.scopusauthoridHerranz, J=7006287307en_HK
dc.identifier.scopusauthoridGavilán, J=7005543869en_HK
dc.identifier.scopusauthoridShaha, AR=7102563293en_HK
dc.identifier.scopusauthoridWei, WI=7403321552en_HK

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