 Patients with advanced head and neck squamous cell carcinoma HNSCC may benefit from organ-preservation treatment based on combination of chemotherapy and radiotherapy without compromising disease-free and overall survival. In patients with initially advanced regional disease, there is controversy about the place of routine planned lymph node neck dissection after chemoradiotherapy, especially in responding patients without clinically invaded residual lymph nodes. There is uncertainty about the lymph nodes status after chemoradiation because the structural imaging modalities CT, MRI lack sensitivity and specificity : small positive lymph nodes are not detected, and residual large lymph nodes can be sterilized ghosts nodes with no sign of viable tumor cells at histopathology. Despite the absence of evidence based on prospective study, in numerous institutions currently, head and neck surgeons are quite reluctant to operate on for neck dissection patients with a complete clinical and radiological response following chemoradiation. 