This is another controversial issue concerning functional neck dissection. Again, most doubts in this respect come from the early days when functional neck dissection was considered insufficient.
Although not unanimously recognized, the number of positive nodes in the neck dissection specimen may harbor prognostic information. However, the exact number of nodes defining the chances for a poor outcome vary in different studies. On the other hand, in some series, the number of nodes is not considered to be important from the prognostic standpoint. In any case, selection of the surgical approach to the neck should not be indicated by the number of nodes, but by the characteristics of every single node that has been detected in the patient's neck.
Functional neck dissection can be performed in patients with nonpalpable and small palpable mobile nodes (usually smaller than 2.5 cm), the size being just a merely orientating factor. The operation is totally safe in patients with multiple nodes, as long as all nodes fulfill these criteria. In these cases, radical neck dissection will not be safer than a functional approach. Thus, it is not the number of nodes that is important, but their clinical characteristics.
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