Are fixed cervical lymph node metastases always inoperable?
Between 1977 and 1980 22 head and neck patients with large fixed lymph node metastases were operated 3 to 8 weeks after preoperative radiotherapy to 60 Gray. Six tumor-free survivals of more than 3 years prove that the fixation of lymph nodes, though serious, does not automatically mean inoperability. When the primary tumor is under control, it is always worth while to explore the neck. The actual reconstruction of the soft tissue cover is no longer a problem. And since the carotid artery can either be ligated (under EEG control) or by-passed, the real danger comes from deep loco-regional invasion into the base of the skull, the intervertebral foramina and the suprahyoid muscles. A specialized and if necessary a polydisciplinary approach is advocated to give these patients a reasonable chance of operability with a quantitatively and qualitatively decent survival.
