UNASSIGNED: This population-based study aims to assess the survival benefits of selective neck dissection (SND) compared to neck observation in patients with T1/T2N0M0 major salivary gland malignancy (MSGC).
UNASSIGNED: We conducted a retrospective review of T1/T2N0M0 MSGC patients who underwent primary tumor surgical extirpation with or without elective neck dissection in the Surveillance, Epidemiology, and End Results database (SEER) from 2004-2015. The impact of SND and clinical variables on overall survival (OS) and disease-specific survival (DSS) was evaluated using Univariate and Multivariate Cox proportional hazards regression models. Kaplan-Meier survival curves were generated, and survival rates were assessed via the log-rank test.
UNASSIGNED: Of 3778 post-operative T1-T2N0M0 MSGC patients, 2305 underwent elective neck dissection, while 1473 did not. Median follow-up was 106 months. Univariate and Multivariate analysis identified SND as a prognostic factor for OS in all the study population. After stratified analysis, we found that in the poorly high-grade (differentiated and undifferentiated) patients, the survival showed a significant OS and DSS benefit after receiving SND compared with the neck observations [HR for OS (95%CI): 0.571(0.446-0.731), P<0.001] and [HR for DSS (95%CI): 0.564(0.385-0.826), P=0.003], other than in the well differentiated or moderately differentiated subgroup. Especially, when the pathological is squamous cell carcinoma, the results show that the people underwent SND had better prognosis, not only in OS [HR (95%CI): 0.532(0.322-0.876), P=0.013], but also in DSS [HR (95%CI): 0.330(0.136-0.797), P=0.014]. The multivariate analysis also yielded encouraging results, compared with neck observation, receiving SND bought about a significant independent OS (adjusted HR, 0.555; 95% CI, 0.328-0.941; P=0.029) and DSS (adjusted HR, 0.349; 95% CI, 0.142-0.858; P=0.022) advantage in high grade squamous cell carcinoma MSGC patients. The Kaplan-Meier survival curves also demonstrated that adjusted SND still had significantly better OS(P=0.029) and DSS(P=0.022) than the observation group in patients with high-grade squamous cell carcinoma of MSGC.
UNASSIGNED: Poorly differentiated and undifferentiated T1/T2N0M0 major salivary gland malignancy treated with selective neck dissection demonstrated superior survival compared to neck observation, especially in the pathological subtype of squamous cell carcinoma. These findings suggest the potential benefits of multimodal therapy for appropriately selected patients, emphasizing significant clinical implications.

Objective:To analyze the clinical, pathological features and metastatic regularity of cervical lymph node metastasis in cN+ laryngeal squamous cell carcinoma, and to explore its diagnosis and management. Methods:Among 1030 patients with laryngeal squamous cell carcinoma who underwent surgery in the Department of Otolaryngology, The First Affiliated Hospital of Chongqing Medical University from March 2011 to January 2021, 83 patients with cN+ were included in the retrospective analysis of clinical data and follow-up data. Results:Among the 83 cases of cN+ laryngeal carcinoma, there were pN+65 cases and pN-18 cases. The false positive rate of cN+ was 21.7%. cN+ cervical lymph node metastasis was related to classification and staging, and the difference was statistically significant（P<0.05）.The false positive rate of cN+ in different types of laryngeal carcinoma was 57.7% （16/27） in glottic type and 3.9% （2/55） in supraglottic type. With the increase of T stage, the false positive rate decreased.The false positive rates of different CT imaging features were as follows:①Size:the critical lymph nodes of more than 2 sizes were 27.3% （3/11）, the 1~3 cm of lymph nodes was 29.4% （15/51）, and the lymph nodes > 3 cm were not false positive （0/21）;②The enhancement types of uniform enhancement, non-uniform enhancement and circular enhancement were 34.3% （12/35）, 31.6% （6/19） and 0% （0/29） respectively. ③The proportion of unclear shape and boundary of lymph nodes was 0（0/24）.The neck recurrence rate was 2.4% in the selective neck dissection （SND） and 20.0% in the non-SND. The 3-year neck area control rates of SND and non-SND group were 93.7% and 81.1% respectively, and the difference was statistically significant （P < 0.05）. The 3-year cumulative survival rates of pN+ group and pN- group were 75.5% and 87.5%, respectively, and there was no significant difference between the two groups （P > 0.05）. The 3-year cumulative survival rates of lymph node extranodal extension ENE+ group and ENE- group were 50.6% and 79.3%, respectively, and the difference was statistically significant （P < 0.05）. Conclusion: There is false positive in cN+ laryngeal carcinoma, which is related to tumor classification and staging. Preoperative imaging diagnosis of cN+ should not be over-dependent on size, but should be combined with the specific manifestations of lymph node metastasis such as circular enhancement and unclear boundaries. Proper use of SND in the treatment of cN+ laryngeal carcinoma is safe and effective, and reduces the risk of overtreatment. In patients with pN+ laryngeal carcinoma, postoperative supplementary treatment can improve the neck control rate and survival rate. However, even if postoperative treatment is performed in patients with ENE+, it is still an unfavorable factor affecting the prognosis.
目的：分析cN+喉鳞状细胞癌颈淋巴结转移的临床、病理特点及转移规律，探讨其诊断及处理方式。 方法：从2011年3月—2021年1月于重庆医科大学附属第一医院耳鼻咽喉科手术治疗的1030例喉鳞状细胞癌患者中纳入83例cN+患者进行临床资料及随访资料的回顾性分析。 结果：83例cN+喉癌中，术后pN+65例，pN-18例，cN+假阳性率为21.7%。cN+颈淋巴结转移与分型分期有关，差异有统计学意义（P<0.05）。不同分型喉癌cN+假阳性率，声门型57.7%（16/27），声门上型3.9%（2/55）。随T分期增加，假阳性率降低。不同CT影像学特征的假阳性率：①大小：2个以上临界淋巴结为27.3%（3/11），淋巴结1～3 cm为29.4%（15/51），淋巴结>3 cm无假阳性（0/21）；②强化类型：均匀强化为34.3%（12/35），不均匀强化为31.6%（6/19），环形强化为0%（0/29）；③淋巴结形态及边界不清为0（0/24）。择区颈淋巴结清扫术（SND）组颈部复发率为2.4%，非SND组为20.0%，复发部位均在手术区域内。SND组和非SND组的3年颈部区域控制率分别为93.7%和81.1%，差异有统计学意义（P<0.05）。pN+组和pN-组3年累积生存率为75.5%和87.5%，其差异无统计学意义（P>0.05）。淋巴结包膜外侵犯（ENE）组和ENE-组3年累积生存率分别为50.6%和79.3%，差异有统计学意义（P<0.05）。 结论：cN+喉癌存在假阳性，并与肿瘤分型分期有关。术前影像学对cN+的诊断不宜过度依赖大小，应结合环形强化和边界不清等淋巴结转移的特异性表现。恰当应用SND治疗cN+喉癌安全有效，并可减少过度治疗的风险。pN+喉癌患者，术后给予补充治疗能提高颈部控制率及生存率。但ENE+患者即使进行术后治疗，仍然是影响预后的不利因素。.

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OBJECTIVE: To explore the applied value of the selective neck dissection to treat second, third, and fourth branchial cleft anomalies with recurrent or repeated neck infections.
METHODS: We made a retrospective study about 29 patients with the second, third, and fourth branchial cleft anomalies with recurrent or repeated neck infections who were treated by surgery from 2002 to 2018 in Sichuan Province Cancer Hospital. According to the characteristics of branchial cleft anomaly on embryology and anatomy, different types of selective neck dissection were chosen to remove pathological scar tissue or inflammatory tissue en bloc.
RESULTS: Of 29 cases, 28 had primary healing, and 1 had local infection, healing after dressing change for a long time. In 1 case, branchial cleft anomalies adhered to the internal jugular vein, which was ruptured and sutured. During the follow-up time of 12∼195 months with an average of 91.76 months, there were no recurrent cases.
CONCLUSIONS: The selective neck dissection technique is safe and effective in the treatment of branchial cleft anomalies with recurrent or repeated neck infection.

Background: Neck lymph node status is the chief prognostic index in patients with head and neck squamous cell carcinoma (SCC), yet the management of a clinically negative neck in this setting is still controversial, especially in patients with laryngeal SCC (LSCC). Objectives: To evaluate the efficacy of selective neck dissection (SND) to control occult disease in patients with LSCC and clinically negative (cN0) necks. Materials and methods: Medical records of 1476 patients with cN0 LSCC were analyzed. In conjunction with primary treatment, 126 (8.5%) underwent at least unilateral elective neck dissection, whereas most 1350 (91.5%) followed a wait-and-see protocol. Prognostic significance was indicated by the Kaplan-Meier survival estimates. Results: The rate of occult neck disease was 15%. Five-year overall and disease-free survival rates were 74.4% and 66.7%, respectively. Prognosis was closely related to T stage, preoperative tracheotomy, and postoperative recurrence. There was no significant correlation with age, sex, or preoperative neck dissection; but in patients with supraglottic LSCC, the relation between prognosis and preoperative neck dissection was significant, with fewer neck and local recurrences than the wait-and-see group (p < .05). Conclusions and significance: Selective neck dissection is serving as an accurate prognostic tool in patients with supraglottic laryngeal cancers.

The management of cervical lymph node metastasis remains a crucial component of the treatment of head and neck cancers. However, the proper management of clinical N 0 cases with early-stage oral squamous cell carcinoma (OSCC) remains undefined. In the advent of minimally invasive techniques in the 1980s, these techniques have gained popularity among numerous surgeons in all fields of surgery. Although there are no randomized controlled trial data comparing the outcomes of minimally invasive techniques (endoscopically assisted selective neck dissection (SND), robot-assisted SND) with conventional techniques, encouraging evidence from several studies suggests that both endoscopically assisted SND and robot-assisted SND are safe, minimally invasive techniques with achieved short-term oncologic outcomes and can reach a better cosmetic outcome than conventional SND. In this review, we also compare the indications, surgical approaches, and relative advantages and disadvantages of conventional SND, endoscopically assisted SND, and robot-assisted SND to provide surgeons with a means to better consider these techniques for the treatment of early-stage OSCC.

Primary tumors of early-stage (T1-2N0M0) head and neck squamous cell carcinoma (HNSCC) can be treated by transoral minimally invasive surgery, but the cervical lymph node lacks corresponding minimally invasive treatment. Therefore, our study was to evaluate the safety and effectiveness of endoscopic-assisted selective neck dissection (EASND) via small lateral neck incision in treatment of early-stage HNSCC.
From May 2008 to April 2012, 29 patients with early-stage HNSCC were enrolled in this retrospective study. EASND via small lateral neck incision was followed by primary tumors treated by transoral endoscopy or CO2 laser microsurgery in all patients. The clinical data and follow-up results were analyzed retrospectively.
Twenty-nine patients (male 22, female 7) were successfully treated by EASND and no case conversed to open surgery. EASND included eight cases of level I-III and 21 cases of level II-IV. The operative time was 68.4 ± 10.3 min, and the operative bleeding was 40.8 ± 12.4 ml. The number of lymph nodes was 19.1 ± 4.1. There were 19 cases of T1, 10 cases of T2, 22 cases of N0, 7 cases of N1, no cases with positive margin or extracapsular spread in lymph node. Temporary sensory changes in the postauricular area occurred in two cases, both recovered within 3 months after the surgery, postoperative seromas occurred in one case. No patient showed postoperative bleeding, chylous fistula, incision infection, facial nerve injury, and accessory nerve injury. All patients were satisfied with the postoperative cosmetic results. The 3-year OS was 96.5 %, while DFS, LRFS, and DMFS were 100 %.
EASND via small lateral neck incision is a feasible and safe technique with achieved short-term oncologic outcomes in early-stage (T1-2N0M0) HNSCC patients. But the long-term results of EASND on oncologic safety and functional outcomes are required to confirm by larger, randomised studies.

OBJECTIVE: Properly management of cervical lymph node metastases is a critical treatment for patients with oral squamous cell carcinoma (OSCC). However there is no consensus on the optimal treatment for oral cancer patients with clinically node-positive (cN+) neck. This study aims to access the feasibility of selective neck dissection in oral cancer patients with cN+neck.
METHODS: We searched PubMed and EMBASE up to April 2015 to identify the studies which compared selective neck dissection (SND) with comprehensive neck dissection (CND) in OSCC patients with cN+neck. Data were extracted by two authors. The meta-analysis was conducted with regional recurrence and disease specific death as primary endpoints.
RESULTS: Five studies with a total of 443 patients met our inclusion criteria. No significant difference was found regarding regional recurrence, disease specific death or overall death between the SND and CND group.
CONCLUSIONS: These findings suggest that cN+OSCC patients treated with SND in conjunction with adjuvant therapy got comparable clinical outcome to CND.

OBJECTIVE: Cervical residue or recurrence of nasopharyngeal carcinoma (NPC) is traditionally treated with radical neck dissection (RND). Because cervical residue patients with NPC exhibit better prognoses than patients with neck recurrence, selective neck dissection (SND) rather than RND may be the optimal treatment for these patients. This study was designed to evaluate the efficacy of SND for the management of neck residue of NPC.
METHODS: Between January 2008 and July 2013, a total of 69 patients were assigned to undergo either RND or SND in the Department of Head and Neck Surgery at Fudan University Cancer Center. The patients\' clinical and pathological characteristics, complications, and treatment outcomes were evaluated and analyzed.
RESULTS: Our study consisted of 69 patients, including 51 in the RND group and 18 in the SND group. There was no significant difference in any clinical or pathological characteristic between the two groups. The overall survival (OS), disease-free survival (DFS), and regional-free survival of all the patients were 79.70%, 61.43%, and 83.30%, respectively, at 3 years and 66.81%, 47.43%, and 78.67%, respectively, at 5 years. No statistically significant difference was found in the OS, DFS, or regional-free survival between the RND and SND groups. The total complication rate was much lower in the SND group (11.11%) than in the RND group. The patients in the RND group experienced longer hospitalization and postoperative hospitalization than those in the SND group.
CONCLUSIONS: SND was demonstrated to be safe and effective for the treatment of neck residue of NPC. The results indicated that patients with neck residue disease who are at stage II to III with a single enlarged lymph node (<1 cm) and only one positive pathological lymph node may benefit the most from SND.

OBJECTIVE: To investigate the incidence of occult nodal metastasis and severity of shoulder dysfunction after selective neck dissection (SND) for recurrent nasopharyngeal carcinoma (NPC) with N0 status.
METHODS: Prospective, single-group, pre/post test design.
METHODS: Academic medical center.
METHODS: Between 1998 and 2012, 46 patients who had recurrent NPC and N0 status were recruited. They subsequently received salvage nasopharyngectomy and SND, removing ipsilateral level I to III and V lymphatics. The incidence of occult nodal metastasis was noted. All patients underwent standardized physiotherapy after surgery. Postoperative shoulder function was measured using the Disability of Arm, Shoulder, and Hand (DASH) questionnaire.
RESULTS: The incidence of microscopic nodal metastasis was 15.2%. For first year posttreatment, the mean DASH score was 44.2. With time, there was no improvement in shoulder function despite targeted physiotherapy (P = .09), and the second postoperative year mean DASH score was 46.3. The degree of daily activity affected was rated as moderate to very limited, and 30% of the patients had at least moderate shoulder pain at rest.
CONCLUSIONS: Shoulder dysfunction after SND for recurrent NPC is significant and persistent. Given the low incidence of microscopic nodal metastasis in such circumstances, routine SND is not recommended.