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10.1245/s10434-007-9680-5
Annals of Surgical Oncology 15:364-370 (2008)
© 2008 Society of Surgical Oncology
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Original Article

Preservation of the Internal Jugular Vein in the Radical Treatment of Node-Positive Neck—Is It Safe?

Everton Pontes Martins, MD, João Gonçalves Filho, MD, PhD, Ivan Marcelo Gonçalves Agra, MD, André Lopes Carvalho, MD, PhD, José Magrin, MD, PhD and Luiz Paulo Kowalski, MD, PhD

Head and Neck Surgery and Otorhinolaryngology Department, Centro de Tratamento e Pesquisa Hospital do Câncer A. C. Camargo, Fundação Antonio Prudente, São Paulo, Brazil

Correspondence: Address correspondence and reprint requests to: Luiz Paulo Kowalski, MD, PhD; E-mail: lp_kowalski{at}uol.com.br

Background: The aim of this study was to evaluate risk factors of neck recurrence in patients with pN+ necks submitted to a modified or a classic radical neck dissection and the safety of preserving the internal jugular vein in the treatment of a subgroup of these patients.

Methods: The medical records of 311 untreated patients with squamous cell carcinoma of the oral cavity (106 cases), oropharynx (95 cases), larynx (49 cases), and hypopharynx (61 cases) were reviewed. Their clinical stages (CS) were CS II in 1%, CS III in 19.9%, CS IVA in 76.2%, and CS IVB in 19.6% of the cases. All patients were pN+.

Results: Ipsilateral neck recurrence occurred in 18 cases (5.8%), 14 cases (4.5%) where the internal jugular vein was resected, and 4 cases (1.3%) where the internal jugular vein was preserved. Neck recurrence did not have significant correlation with tumor site (P = .852), T stage (P = .369), N stage (P = .963), adjuvant radiotherapy (P = .701), number of positive lymph nodes (P = .886), jugular vein preservation (P = .240), and extracapsular spread (P = .670). There was significant correlation between neck recurrence and the lymph node size (.040).

Conclusions: Modified radical neck dissection with internal jugular vein preservation can be performed in selected patients with lymph node metastases, with no significant increase in the risk of neck recurrence.

Key Words: Internal jugular vein • Radical neck dissection • Node-positive neck • Head and neck cancer






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