Morbidity and Complication Rates of Neck Dissections

:
A Comprehensive Comparison of 200 Consecutive Cases
Eric J. Moore, MD, Siva Chinnadurai, MD, Kerry D. Olsen, MD, Jan L. Kasperbauer, MD
Department of Otorhinolaryngology
Mayo Clinic, Rochester, MN
BACKGROUND
Neck dissection has played a vital role in the
management of head and neck cancer since its
introduction in 1906 By George Crile. In the
early years of neck dissection, morbidity was
accepted and even expected from such a
substantial surgical procedure. However, as
techniques and technology have advanced, so
have expectations from neck dissections. It is
vital to understand how the timing and extent of
neck dissection relates to realistic postoperative
expectations in terms of adverse events.

METHODS
The charts of 200 consecutive patients
undergoing neck dissections by three
head and neck surgeons were
reviewed. These were analyzed for
adverse outcomes at 3 and 6-months
after surgery. Patients were
categorized according to a number of
different factors including those in
whom the current neck dissection was
the primary or secondary form of
treatment, whether neck dissection
was unilateral or bilateral, and the
extent of neck dissection (Select,
modified radical with CN XI sparing,
modified radical with CN XI sacrifice,
and radical). The rate of adverse
outcomes was then analyzed for
statistical significance using the 2sided Fisher exact test.

RESULTS
Of the 200 patients, 102 had no prior therapy and
147 received unilateral neck dissection. The 98
patients that received prior therapy received, as a
group, a variety of treatments including radiotherapy,
chemotherapy and previous surgery. 194 patients
received neck dissection as a therapeutic treatment.
Of these, various types of neck dissections were
employed, 6-radical, 5-MRND with CN XI sacrificed,
81-MRND with CN XI preserved, 102-SND. 6
patients received elective neck dissection which was
either MRND or SND. All patients were given postoperative instructions for neck, shoulder, chest and
arm physiotherapy.
Among the 102 patients that received no prior
therapy, complications arose in 12. This is compared
to 22/98 patients that did receive prior therapy. A
total of 11 of 98 (11.25%) patients developed
shoulder weakness after neck dissection with prior
therapy. Of patients with no prior therapy, 4/102
(3.9%) developed shoulder weakness. There was a
significant difference in shoulder weakness between
patients with and without prior therapy; however,
other complications showed no significant difference
whether or not there was prior therapy involved.
(Table 1)
Out of 147 patients who received unilateral
dissection, 29 had some type of complication
(26.5%), compared to 5/53 patients who received
bilateral dissection (9.4%). When a bilateral neck
dissection was performed, patients experienced
more frequent shoulder weakness; however the
differences in all adverse outcomes were not
interpreted as statistically significant. (Table 2)
Among the 81 patients treated with MRND with
preservation of CN XI, an adverse outcome was
experienced in 21 (25.9%), with 11 (13.6%) of the
patients experiencing shoulder weakness. Of the
102 patients treated with SND, 9 (8.8%) had an
adverse outcome, with 4 (3.9%) patients
experiencing shoulder weakness. There is a
significant difference in incidence of shoulder
weakness; patients who were treated by SND had
significantly less shoulder weakness than those
treated with MRND with preservation of CN XI.
Those who were treated with MRND where CN XI
was sacrificed experienced fewer complications than
MRND where CN XI was preserved, however this
could be an artifact from the small sample size.
Patients treated with SND overall had less
complications than if they were treated with MRND.
(Table 3)

Table 1: Primary vs Secondary Treatment

Table 2: Unilateral vs Bilateral Dissection
No
(N=147)

Yes
(N=53)

Fisher’s
Exact Test,
two-sided pvalue

Major
complication

3 (2.0)

0

0.57

0.062

Shoulder
weakness

10 (6.8)

5 (9.4)

0.55

2 (2.0)

0.68

VII weakness

6 (4.1)

0

0.34

0

2 (2.0)

0.24

Tongue
weakness

2 (1.4)

0

1.00

Infection

0

2 (2.0)

0.24

Infection

2 (1.4)

0

1.00

Seroma

1 (1.0)

2 (2.0)

0.62

Seroma

3 (2.0)

0

0.57

Hematoma

1 (1.0)

0

1.00

Hematoma

1 (0.7)

0

1.00

First bite pain

2 (2.0)

0

0.50

First bite pain

2 (1.4)

0

1.00

Type of
Complication, n
(%)

Prior Therapy
No
(N=102)

Yes
(N=98)

Fisher’s
Exact Test,
two-sided pvalue

0

3 (3.1)

0.12

Shoulder
weakness

4 (3.9)

11 (11.2)

VII weakness

4 (3.9)

Tongue
weakness

Major
complication

Type of
Complication, n
(%)

Bilateral Dissection

Table 3: Extent of Dissection
Type of Complication,
n (%)

Radical
(N=6)

Modified- XI
sacrificed
(N=5)

Modified-XI
preserved
(N=81)

Selective
(N=102)

END
(N=6)

Fisher’s
Exact Test,
two-sided
p-value †

Major complication

0

0

3 (3.7)

0

0

0.08

Shoulder weakness

0

0

11 (13.6)

4 (3.9)

0

0.03

VII weakness

0

0

4 (4.9)

2 (2.0)

0

0.41

1 (17)

0

0

0

1 (17)

1.00

Infection

0

0

2 (2.5)

0

0

0.19

Seroma

0

0

0

3 (2.9)

0

0.26

Hematoma

0

0

1 (1.2)

0

0

0.44

First bite pain

0

0

0

0

2 (33)

1.00

Tongue weakness

Type of Neck Dissection

CONCLUSIONS
Neck dissection is an integral part of the management of head and neck cancer. An understanding of the adverse
outcomes associated with these types of procedures is required to make appropriate decisions and to counsel patients.
Shoulder dysfunction is the only adverse outcome that varies significantly between treatment groups, and this is primarily
affected by prior therapy to the neck and the extent of neck dissection. Adverse outcome rates in bilateral neck
dissections do not significantly differ from those in unilateral dissections.
© 2008 Mayo Foundation for Medical Education and Research