Current concepts in surgical management of neck metastases from head and neck cancer.

The surgical management of neck metastases from head and neck cancer consists primarily of neck dissection. An awareness of both the cervical anatomy and natural history of squamous cell carcinoma of the upper aerodigestive tract is necessary to understand the role of neck dissection and to appreciate when it may be appropriate to modify the standard radical neck dissection. The use of imaging to augment palpation of the neck has resulted in greater accuracy in identifying neck metastases and has further clarified the role of modified neck dissections. Depending on the site and size of the primary tumor, radiation therapy, modified neck dissection, or selective neck dissection are all appropriate options for the elective treatment of the neck when there is a high risk of occult metastasis. Therapeutic neck dissection alone is adequate for early-stage neck disease, but must be combined with irradiation for more advanced stages. Regional control of tumor metastases is highly dependent on the stage of neck disease and the presence of extranodal cancer spread.