Is there a rule of thumb regarding timing of a neck dissection? My mom is about seven weeks post chemoradiotherapy and her doc recommended a neck dissection as a preventative measure. Initially they told me it should be done within four to six weeks of therapy, but they keep rescheduling her to accommodate other surgeries. I certainly understand the need to operate on those with more aggressive problems, but I don't want to put my mom's health in jeopardy either. Thanks.
D

Hi Didier:

I hope your mom is doing okay. In general, neck dissection is often performed before radiation and/or chemotherapy in which case radiation starts about 6 weeks after the surgery provided there are no complications.The person who has a neck dissection will also often have a prophylactic tracheotomy post-operatively and this may take up to a few weeks to close. If your mom has a G-tube from radation, it's best to leave it in until surgery is completed.

For those who have large or awkward tumors to access and resect, radiation may be done first followed by neck dissection. Anecdotally (and Brian edit as needed), I often see these done about 6 weeks after also. The important factor with this approach is that the post-radiation neck is often more difficult to work with because the tissue changed from radiation and becomes sort of gummy and glue-like to try to manipulate. It's really important to ask your surgeon if he/she thinks this is a factor in your mom's case.

The staging and nodal involvement of the initial tumor often helps a surgeon decide whether ot not to recommend a neck dissection as well. Can you tell us a bit more about your mom's specific case? Also, does she have any other major medical problems?

Kim

Hi, she had induction chemo followed by a continuous 5-FU infusion during her inpatient weeks for radiation (47 IMRT treatments). She is stage IV with two lymph nodes involved. She's 70 and in otherwise pretty good health, with the exception of having developed a periodic drop in blood pressure. At first I thought the drop may be caused by dehydration, but that doesn't seem to be the case. Every now and then she experiences a spike in heart rate followed by the drop in BP. I'm now wondering if all the months in bed might have brought on a clot and thus the drop in BP. The docs haven't been very helpful regarding this one. I've digressed, sorry.
Sincerely,
Didier