𝔖 Bobbio Scriptorium
✦   LIBER   ✦

Efficacy of neck dissection: Are surgical volumes important?

✍ Scribed by Randall P. Morton; Lincoln Gray; Dev A. Tandon; Mark Izzard; Nicholas P. McIvor

Publisher
John Wiley and Sons
Year
2009
Tongue
English
Weight
186 KB
Volume
119
Category
Article
ISSN
0023-852X

No coin nor oath required. For personal study only.

✦ Synopsis

Abstract

Objectives/Hyphothesis:

Surgical volumes have been shown in many fields to reflect expertise and to be associated with improved clinical outcomes. We sought to test similar hypotheses that neck dissection is a volume‐sensitive procedure wherein the number of lymph nodes harvested and clinical outcomes are correlated with the number of neck dissections performed.

Methods:

We conducted a retrospective analysis of 375 neck dissections. The number of nodes harvested was examined by multiple linear regression before and after mathematical correction for pathologists' variation over time. The prior experiences of the surgeons were also averaged, depending on whether there was regional recurrence after at least 9 months of follow‐up.

Results:

More nodes were found by the pathologists over time, with 2.1 more nodes being found on average for each successive year (P < .001). After correcting for this effect of time, there remained a significant relationship between surgeons' experience and number of nodes harvested (P < .003). Additionally, cases that recurred were operated by less‐experienced surgeons (P = .02).

Conclusions:

We have demonstrated that there is a β€œlearning curve” for neck dissection. Our most experienced surgeon harvested on average 11 more nodes than similar specimens submitted by the group of inexperienced surgeons. The effect of experience remains significant even without adjusting for time (P < .001). Surgical experience also affects clinical outcome months after the dissection. This retrospective review supports surgical volume as an indicator of expertise in neck dissection that could be used to assess trainees' progress and for quality assurance in large head and neck units. Laryngoscope, 2009

πŸ“œ SIMILAR VOLUMES

Efficacy of selective neck dissection fo
Efficacy of selective neck dissection for nodal metastasis with involvement of nonlymphatic structures
✍ Muthuswamy Dhiwakar; K. Thomas Robbins; Krishna Rao; Francisco Vieira; James Mal πŸ“‚ Article πŸ“… 2010 πŸ› John Wiley and Sons 🌐 English βš– 99 KB

## Abstract ## Background. Our aim in carrying out this study was to determine the efficacy of selective neck dissection (SND) for cervical metastases with clinical involvement of adjacent nonlymphatic structures. ## Methods. In all, 39 patients were retrospectively analyzed with respect to 43 e

Efficacy of routine bilateral neck disse
Efficacy of routine bilateral neck dissection in the management of the N0 neck in T1–T2 unilateral supraglottic cancer
✍ Juan P. Rodrigo; RubΓ©n Cabanillas; Virginia Franco; Carlos SuΓ‘rez πŸ“‚ Article πŸ“… 2006 πŸ› John Wiley and Sons 🌐 English βš– 132 KB πŸ‘ 1 views

Background. The treatment of the clinically negative (N0) neck in supraglottic laryngeal cancer continues to be an area of controversy. The aim of this study was to analyze the long-term efficacy of routine bilateral neck dissection compared with ipsilateral neck dissection in T1-T2 N0 lateral supra

Transverse process of the atlas(C1)β€”an i
Transverse process of the atlas(C1)β€”an important surgical landmark of the upper neck
✍ Tzung-Shiahn Sheen; Tsung-Te Chung; Carl H. Snyderman πŸ“‚ Article πŸ“… 1997 πŸ› John Wiley and Sons 🌐 English βš– 255 KB πŸ‘ 1 views

Background: The internal carotid artery, the internal jugular vein, and the spinal accessory nerve are the main structures that are preserved in conservative neck dissections. In the upper neck, one surgical landmark used to find these structures is the transverse process of a cervical vertebral bod

Efficacy of salvage neck dissection for
Efficacy of salvage neck dissection for isolated nodal recurrences in early carcinoma of oral tongue with watchful waiting management of initial N0 neck
✍ Raymond King Yin Tsang; Joseph Chun Kit Chung; Victor Shing Howe To; Jimmy Yu Wa πŸ“‚ Article πŸ“… 2010 πŸ› John Wiley and Sons 🌐 English βš– 107 KB πŸ‘ 1 views

## Abstract ## Background Recent studies have shown that salvage treatment may be effective for early tongue carcinoma with nodal failures after watchful waiting policy. We wanted to assess the efficacy of salvage neck dissection. ## Methods We conducted a retrospective review of all patients wi