The impact of neck dissection on health-related quality of life

Objective: To compare health-related quality of life in patients having no neck dissection and those having a selective dissection, with particular reference to shoulder dysfunction. Design: Prospective study Setting: Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, England. Patients: Two hundred seventy-eight consecutive patients undergoing primary surgery for previously untreated oral and oropharyngeal squamous cell carcinoma between january 1, 1995, and December 31, 1999. Main Outcome Measure: The University of Washington Quality of Life questionnaire, administered on the day before surgery and at 6 months, at 12 months, and more than 18 months after surgery. Results: No neck dissection was performed in 58 patients (21%), a unilateral dissection in 181 (65%), and a bilateral dissection in 39 (14%). Patients with no neck dissection and those with unilateral level III or IV dissections had similar mean scores for shoulder dysfunction, whereas patients with unilateral level V and bilateral level III and IV dissections recorded much worse scores on average. Conclusions: There is little subjective morbidity associated with shoulder dysfunction after a unilateral level III or IV neck dissection compared with patients undergoing primary surgery without a neck dissection. More extensive surgery in the neck, whether bilaterally removing levels I to III or IV or extending posteriorly to include level V, is associated with statistically significantly worse shoulder dysfunction.