From January 1960 to December 1977, 61 patients had a simultaneous one-stage bilateral neck dissection with or without excision of the primary lesion, while 63 patients had a therapeutic second (two stage) neck dissection performed by our service. In ten patients, one or both of the internal jugular veins and spinal accessory nerve were preserved. Patients in both groups were staged, using the American Joint Commission 1977 clinical classification. All the pathologic specimens had lymph node clearance done. Simultaneous bilateral neck dissection, in the present study, has an operative mortality of 10%, with 11% life-threatening complications and with 62% significant postoperative facial swelling. There is an overall three- and five-year survival rate of 20% and 12.5%. Patients who had bilateral staged neck dissection had complications seen in 54%, with a 3.2% mortality rate. The overall three- and five-year survival in this group of patients was 60% and 38%, respectively.

The presence of bilateral cervical nodal metastases secondary t o intraoral, laryngeal and hypopharyngeal carcinoma was once thought t o make the condition inoperable and "incurable". It was also stated that the mortality from bilateral neck dissection would most likely exceed the number of patients cured by this procedure. We have a number of patients who had and tolerated it well, with a few surviving even for three and five years. We wish t o report the morbidity, mortality and cure rate with simultaneous bilateral neck dissection in patients who had this procedure.sections were performed as a part of oral, laryngeal or hypopharyngeal resections. Fifty-three patients had a classical bilateral radical neck dissection while in six patients one of the internal jugular veins and in two patients both of these veins were preserved. Six out of 61 (9%) patients had received radiation therapy previously. Nodal clearance was done in all the patients. Six out of 61 (8%) patients died within one month, three of whom never regained consciousness and died within 48 hours of the procedure. Sixty-three percent (39/55) of patients developed immediate postoperative facial swelling and wound infection. Thirty-six percent (22/5 5 ) had orocutaneous fistulae; of these, 11% (7/55) had carotid artery blowouts. Sixteen percent (10/55) of patients had significant pulmonary complication. The percentage of patients who were free of disease at 6 months, 1 year, 1% years, 3 years, and 5 years following the procedure was 54% (26/48), 37% (18/48), 29% (14/48), 20% (10/48) and 12.5% (6/48), respectively.It appears from the present study that although bilateral neck dissection has a high postoperative morbidity and mortality rate, it can effectively control the disease in a significant number of patients with a 20% three-year and 12.5% five-year cure rate.

From January 1963 to December 1977, 63 patients underwent a therapeutic second (staged) neck dissection at our institute. The mean interval between the first neck dissection and the second neck dissection was 13.2 months; 58.7% of the second neck dissections were performed between 6 and 12 months after the first. Forty-six patients had histologically positive and 17 patients had histologically negative nodes in the first neck clearance; 57 patients had histologically positive and 6 patients had histologically negative nodes in the second neck clearance. Forty-two of the 63 patients had bilateral nodal disease, while 2 patients had no disease in either side of the neck. Fifty-four percent of the patients had postoperative complications; 30% developed immediate postoperative edema, and 14% had wound infection. The overall three-year and five-year survival rates were 60% and 38%, respectively. Patients who had bilateral histologically positive nodes had a 16% five-year survival rate, while those who had histologically positive nodes in one side of the neck only had a 26% five-year survival rate.

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