Table 7 Pros and cons for elective neck dissection (END)

Neck dissection has low morbidity & mortality

END results in a large number of unnecessary surgical procedures and is associated with inevitable morbidity

Cure rate for neck dissection is decreased if gland enlargement occurs or multiple nodes appear

Cure rates are no lower if the surgeon waits for the neck to convert from N0 to N1

It is impossible to provide follow-up necessary to detect the earlier conversion of a neck from N0 to N1

Careful clinical follow-up will allow detection of the earliest conversion from N0 to N1

Allowing the neck metastases to develop increases the incidence of distant metastasis

END removes the barrier to the spread of disease and also has a detrimental immunological effect

If neck has been entered to remove the primary it is better to perform an in-continuity resection

Radiation is as effective as neck dissection in N0 neck

   High incidence of occult metastatic disease