Neck dissection

A neck dissection is a surgical procedure involving the removal of lymph nodes and surrounding tissue from the neck. It is primarily performed to treat or prevent the spread of cancer, particularly head and neck cancers, by removing potentially affected lymphatic tissue.

What is the purpose of a neck dissection?

The primary purpose of a neck dissection is to remove lymph nodes that may contain cancer cells to prevent the spread of the disease. It helps in staging the cancer, determining the extent of disease spread, and planning further treatment. Neck dissection also aids in reducing the risk of cancer recurrence and improving overall prognosis.

When is a neck dissection performed?

A neck dissection is typically performed in cases of head and neck cancers, including those of the oral cavity, oropharynx, larynx, and thyroid. It is indicated when there is clinical or radiological evidence of lymph node metastasis, or sometimes prophylactically in high-risk cases where the likelihood of metastatic spread is significant.

Anatomical levels of the neck

The neck is divided into several anatomical levels to describe the locations of lymph nodes:

• Level I: Submental and submandibular nodes
• Level II: Upper jugular nodes
• Level III: Middle jugular nodes
• Level IV: Lower jugular nodes
• Level V: Posterior triangle nodes
• Level VI: Pretracheal, paratracheal, and prelaryngeal nodes (central compartment)

Most pathology reports will describe the number of lymph nodes examined at each level and the number that contain cancer cells. This detailed reporting is crucial for accurate staging and treatment planning.

How is a neck dissection examined?

The removed tissue from a neck dissection first undergoes a gross examination to identify and isolate the lymph nodes. The purpose of this step is to ensure that all potentially affected nodes are collected and prepared for further analysis. This is followed by a microscopic examination to determine which, if any, lymph nodes contain cancer cells. Pathologists assess the number of lymph nodes involved and the levels of the involved lymph nodes, the size of metastatic deposits, extranodal extension, and other histological features. This examination helps in staging the cancer and guiding further treatment decisions.

How do the results of a neck dissection impact treatment?

The results of a neck dissection significantly impact the subsequent treatment plan:

• Positive lymph nodes: Indicate the need for additional therapies such as radiation or chemotherapy to address potential residual disease.
• Number of affected nodes and extranodal extension: Can influence the choice and intensity of adjuvant therapy.
• Staging information: Helps in accurately determining the cancer stage, which is crucial for prognostication and treatment planning.

Overall, the findings from a neck dissection guide oncologists in tailoring treatment plans to achieve the best possible patient outcomes.

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