Abstract
Introduction
This study aims to quantify surgical site complications (SSC) after isolated salvage
neck dissection (ND) compared with primary ND.
Patients and methods
Between 1997 and 2017 in the Netherlands Cancer Institute - Antoni van Leeuwenhoek,
a total of 323 isolated NDs were performed in 308 patients: primary ND (n = 144),
post-radiotherapy (RT) ND (n = 53) and post-chemoradiotherapy (CRT) ND (n = 126).
Patient, tumor and therapy characteristics were recorded. SSCs were scored according
to the Clavien-Dindo Classification (CDC).
Results
101 NDs (31%) were complicated by at least one SSC. In total, 189 different SSCs occurred.
Translated to CDC, 45 complications were grade 2, 25 grade 3a and 31 grade 3b. No
significant difference in occurrence of SSC (CDC >1) was found between all groups.
However, post-CRT, selective (SND) and modified radical ND and radical ND (MRND/RND)
(p = 0.005), resection of sternocleidomastoid muscle (SCM) (p = 0.039) and duration
of super selective ND surgery (p = 0.048) were significantly associated with more
SSC. SCM muscle removal was associated with more surgical site infection (p = 0.045)
and necrosis (p = 0.036). From week 10 post-RT/CRT, no difference in complication
frequency with primary ND was seen.
Conclusion
Post-CRT SND, MRND/RND and SCM muscle resection were associated with an increased
incidence of SSCs. If oncologically possible, limit the extent of ND and when an MRND
is inevitable, preserve the SCM muscle for optimal prevention of SSC. Concerning SSC,
optimal timing of salvage ND is minimal 10 weeks after RT/CRT.
Keywords
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Article info
Publication history
Published online: December 26, 2022
Accepted:
December 19,
2022
Received in revised form:
December 6,
2022
Received:
October 17,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
