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

From: Neck dissections: radical to conservative

For END Against 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