The development of radical neck dissection as a standard technique for the treatment of gross and suspected meta-static cancer in the lateral neck is traced and the current operation discussed.
Radical neck dissection evolved from a series of regional and localized procedures about the oral cavity, laryngopharynx, and neck over a period of 200 years and reached its primacy in the 1950s. The concept of the operation is to remove the repository lymph node system and all associated fat, fascia, muscles, nerves, and blood vessels in that area with the exception of the carotid artery and vagus nerve, and thus to attempt to control the spread of cancer by ablation of this facility. The technique was expanded to include the primary cancer and the contralateral neck when realistic.
The operation has proved effective and superior to any previous concepts of management. Counterbalancing this success are a troublesome incidence of local recurrence of neoplasm at the primary site and in the lateral neck, technical and physiological restrictions on the extent of dissection, and inevitable regional deficits in function and body image. Imaginative modifications in treatment incorporating irradiation and chemotherapy have been combined with radical neck dissection to improve local control of the cancer, but these also have some restrictions and deficits, and are now in the process of being sorted out.
The basic operation has undergone modification to conserve the somatic functional architecture of the neck: only the lymph node system and its fascial envelope are removed. This conservation operation is an inevitable part of the continuing development of the therapeutic program. The understandable controversial aspects will ultimately be settled by comparisons of the curability data. At present, however, the classic radical neck dissection remains the basic method for control of metastatic cancer in the neck, sharing this responsibility with preoperative and postoperative irradiation and, in certain instances, with conservation surgery in a developing incorporation of interdisciplinary approaches.
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