Thirty-year experience with 457 radical neck dissections in cancer of the mouth, pharynx, and larynx.

A retrospective analysis of 457 radical neck dissections (RNDs) performed for epidermoid cancers of the head and neck was performed. There was a 27 percent overall neck recurrence rate, 17 percent being confined to the neck. Only 5 percent occurred in the ipsilateral dissected neck. Failure in the neck correlated well with the node stage at the time of surgery, but was not affected by the size of the primary tumor, the timing of the RND, or the type of RND performed. Treatment of neck recurrences was predominantly surgical, with a 56 percent local control and a 24 percent disease-free survival rate. Overall disease-free survival was 53 percent, ranging from 68 to 29 percent according to the node stage. Survival was further affected by the size of the primary tumor and failure to control disease in the neck; it was not affected by the type of RND or its timing, or the addition of radiotherapy. Overall recurrence after modified RND was 28 percent. Increased neck recurrences were noted only in N2 and N3 cases, although survival was not affected even in these late stages.