• Providers and Locations
• Audiology
• Balance Center
• Cranial Base Surgery
• Facial Plastic and Reconstructive Surgery
• General Otolaryngology
• Head and Neck Cancer Surgery
• Rhinology (Sino-Nasal Conditions and Surgery)
• Otology/Neurotology
• Smell and Taste Disorders
• Speech-Language Pathology
• TransOral Robotic Surgery
  • Benefits
  • What to Expect
  • Before TORS
  • Staging Endoscopy for Appropriate Patient Selection
  • After TORS
  • Staged Neck Dissection after TORS
  • Postoperative Radiation after TORS
  • TORS for Sleep Apnea
  • News
  • Patient Testimonials
  • Frequently Asked Questions
  • Team
  • Locations
  • Travel Information
  • History of TORS
• Voice, Speech and Swallowing Disorders

For Patients Make an Appointment Encyclopedia Articles about Ear, Nose and Throat

What is a Neck Dissection and Why Might the Patient Need This?

A neck dissection is used to remove the lymph nodes in the neck for cancers of the throat and voice box. This is done through a neck incision and is not done robotically. In the vast majority of cases, this can be accomplished with a “selective” neck dissection that allows for removal of mainly fat and lymph nodes with preservation of other important neck structures. These are reconstructed in a very cosmetic fashion. In addition, even if a patient were to choose no TransOral robotic surgery and was treated with chemoradiation for the throat, many patients would still need or opt for a neck dissection at the end of chemoradiation.

Dr. Weinstein and O'Malley et al recently reported on 100% control in the operated necks of patients with advanced orpopharyngeal cancer that underwent TORS and Selective Neck Dissection.

How is it Determined if the Patient Needs a Neck Dissection?

If a patient has a benign tumor or disease, a neck dissection will not be necessary. A patient that has a cancer of the throat might either have neck lymph nodes involved by the cancer or be at risk for getting lymph nodes involved by the cancer. If the patient has a cancer that already involves lymph nodes or doesn't have any nodes (lumps in the neck) on scans or to touch, but has a cancer which is at high risk of involving the lymph nodes, then it will be recommended that, following TORS, a neck dissection be done, which is almost always done as a separate procedure. This is important because the assessment of the involvement of lymph nodes in the pathology lab is critical to determine if the patient will need any additional treatment such as decreased intensity radiation or chemoradiation.

Why is the Neck Dissection Done Separately from TransOral Robotic Surgery (TORS)?

In the majority of cases, Penn's TORS team believes that it is best to perform the neck dissection on a separate day after robotic surgery. The advantages include:

• Ability to wait for final pathology following TORS in the event further resection is needed.
• Staged neck dissection avoids creating a connection between the TORS throat incision and the neck which might predispose to an infection or require a complex reconstruction to close the hole. Waiting even one week avoids this problem.
• Allows faster oral intake by avoiding a complex reconstruction between the neck and TORS procedure site.
• Avoids airway swelling and minimizes the need for a breathing tube between the neck and the windpipe (tracheostomy).

 

	Need an appointment? Request one online 24 hours/day, 7 days/week or call 800-789-PENN (7366) to speak to a referral counselor.