Salvage Neck Dissection for Cervical Recurrence of Nasopharyngeal Carcinoma

Objective: To evaluate the effectiveness of salvage neck dissection as part of a multidisciplinary treatment approach in persistent or recurrent metastatic nasopharyngeal carcinoma, after failure of initial radiotherapy at the regional site. Design: A retrospective study of 31 patients treated during a 14-year period from March 1981 through May 1995, with a maximum follow-up of 152 months. Factors evaluated include patients' sex, age, and initial stage of tumor, mobility and number of nodal recurrences, surgical and pathological findings, and postoperative irradiation. Setting: Academic tertiary referral center. Patients: Twenty-six men and 5 women were studied; one patient had neck dissection to both sides of the neck on separate occasions, for a total of 32 operations. All patients had pathologically proved nasopharyngeal carcinoma and had been previously treated at the primary site and both sides of the neck with definitive radiotherapy. Intervention: Patients underwent a radical, modified radical, or level I—sparing radical neck dissection. Main Outcome Measure: Surgical morbidity, time to recurrence at the regional site, and survival time. Results: Clinically, there was a disease predilection of 81% at levels II and V. Surgical morbidity was minimal. Regional control was achieved in 20 (65%) of the patients, and the overall 5-year survival was 67%. Tumor involvement of the posterior triangle musculature and spinal accessory nerve was associated with failure to control neck disease. Extracapsular nodal extension correlated with a poor survival outcome. Conclusion: Control of regional disease by salvage neck dissection when radiotherapy has failed is both safe and effective in properly selected patients. Arch Otolaryngol Head Neck Surg. 1997;123:725-729