A neck dissection is a surgical procedure to remove lymph nodes and associated tissue from the neck. This procedure is done as part of a cancer treatment plan for a patient with cancer in or around the neck with the goal of controlling the spread of the cancer and achieving a better patient outcome. It is performed by an otolaryngologist, a surgeon who specializes in head and neck surgery, and patients should expect to spend some time in the hospital after the surgery while they recover.
When patients are diagnosed with cancer of the neck through the use of medical imaging and biopsies, the cancer is staged to determine how far it has spread. This information is used to develop a treatment plan that usually includes chemotherapy and radiation, in addition to a neck dissection.
Neck dissections require general anesthesia and take two to four hours to complete. In a radical neck dissection, all of the lymph nodes are removed along with structures like the submandibular gland and the stemocleidomastoid muscle. This surgery has been used since the early 1900s and is recommended if there is clear evidence of metastasis to the lymph nodes. By taking all of the nodes and linked structures out at the same time, surgeons can remove as many cancer cells as possible and limit the risk of leaving cancer cells behind in the neck.
In modified and selective neck dissections, fewer lymph nodes are removed. These procedures are classified on the basis of the zone in the neck where the surgery is focused and they are used if there are concerns about the spread of the cancer, but no firm documentation of metastasis. Improvements in surgical technique and cancer treatment have made these less radical options more popular as surgeons are more confident that they can preserve neck tissue during a neck dissection without putting the patient in jeopardy.
After a neck dissection, patients will need to eat soft foods for several days and they will start the next phase of cancer treatment. The wound site usually heals with minimal scarring and surgeons are careful to select a fold of the neck for the incision site to disguise the scar as much as possible. Cancer treatment will include follow-up testing to look for any signs of lingering or recurring cancer cells in and around the neck. If the cancer returns, catching it early can improve the patient's chances, as well as reducing the need for invasive procedures.