The cases that died of neck failure, among 271 patients with squamous cell carcinoma of the head and neck who underwent radical neck dissection between 1985 and 1999, were studied with respect to the primary site, operation method, period until nodal recurrence, region of nodal recurrence, and mode of metastasis.
The results were as follows:
1) Of 271 patients, 173 cases were found to have pathologically positive neck lymph nodes, and 13 cases died of neck failure.
2) Primary sites in these 13 patients were the tongue in 9 cases, the lower gum in 3 cases, and the mouth floor in 1 case.
The average period until nodal recurrence was 5.3 months, and the nodal recurrence in 12 cases occurred within 1 year after radical neck dissection.
3) Extracapsular spread was seen in 11 cases (84.6%), in which 11 neck sides (78.6%) were affected out of 14 sides.
The average diameter of the longest metastatic lymph node of each case was 33.4 mm. Even in the 3 neck sides without extracapsular spread, there were multiple metastases, with an average number of 14 metastatic lymph nodes, ranging in 3 to 6 regions.
4) Nodal recurrence was seen in the area of radical neck dissection in all cases, and in the site of extracapsular spread or of primary metastatic lymph nodes.
From these results, it was suggested that the prognosis of patients with multiple metastasis in more than three regions or extracapsular spread is poor.
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