Bilateral Radical Neck Dissection: Results in 193 Cases

Background And Objectives: Indications of simultaneous bilateral radical neck dissection remains controversial. The main objectives of this analysis were to study: a) the frequency of postoperative complications, b) the patterns of metastatic lymph nodes in the surgical specimen, c) the predictive factors of neck recurrences, d) the prognostic factors related to overall survival.

Methods: A retrospective review of results in 193 consecutive patients submitted to a simultaneous bilateral radical neck dissection from 1960-1990.

Results: Postoperative complications occurred in 60.8% of the cases. The most frequent ones were: fistula, wound infection, flap dehiscence and necrosis. There were four postoperative deaths (2.7%). The lymph nodes most frequently involved were of the upper jugular and upper accessory groups. Only patients with lip and paranasal sinus tumors never presented metastatic nodes at Levels IV and V. Tumor recurrences were more common at the ipsilateral neck (13.5%) or at distant sites (12.4%). The predictive factors of neck recurrences were: age, N stage, ipsilateral metastasis at Level II, and contralateral metastasis at Levels II and IV. The overall 5-year survival rates for the two age groups, that is, younger than 40 and older than 40 years of age, were respectively, of 8.5% and 35.6% (P = 0.0296). There were no survivals among the group of patients with neck lymph nodes staged as N3 or Nx. The overall 5-year survival rates were significantly influenced by contralateral metastatic lymph nodes at any level. The results of multivariate analysis using the Cox regression technique, showed that Level II ipsilateral metastatic lymph nodes, Levels II and IV contralateral metastatic lymph nodes, and age were the independent predictors of the risk of death.

Conclusions: This study demonstrates that simultaneous bilateral neck dissection has a high morbidity and should be contraindicated as an elective procedure. Further studies with selective neck dissections are warranted.