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It is suggested that the last major improvement in the surgical treatment of head and neck cancer was Crile's description of radical neck dissection in 1906, and that modifications of this procedure, including extended surgery, have made little or no difference to survival rates. It is hoped that some means may soon be found of identifying those patients with head and neck cancer who do badly--the majority. As a start, it is proposed that patients with an antral carcinoma and a gland in the neck, and patients with hypopharyngeal carcinoma and bilateral neck glands should not be treated by surgery. A retrospective analysis is made of matched pairs drawn from a personal series, one patient in each pair having had a prophylactic neck dissection, and one having been submitted to a policy of 'wait and see'. The survival rate for patients undergoing prophylactic neck dissection was worse than that of the wait and see group; this difference was statistically significant.