Selective neck dissection for clinically node-positive oral cavity squamous cell carcinoma.

Area of Science:

• Oncology
• Head and Neck Surgery
• Cancer Research

Background:

• Management of clinically node-positive (cN+) neck is crucial in oral cavity squamous cell carcinoma (OSCC).
• The extent of neck dissection (ND) for cN+ OSCC remains a subject of debate.
• Evaluating the necessity of including levels IV and V in therapeutic ND is important.

Purpose of the Study:

• To determine if levels IV and V can be excluded in therapeutic neck dissection for cN+ OSCC patients.
• To assess the risk of metastasis to levels IV and V in cN+ OSCC.
• To compare outcomes of selective versus comprehensive ND in specific cN+ OSCC subgroups.

Main Methods:

• Retrospective chart review of 92 patients with cN+ OSCC.
• Patients underwent either comprehensive or selective neck dissection.
• Data collected from January 1993 to February 2009.

Main Results:

• Metastasis to level IV or V occurred in 22% of ipsilateral necks.
• 16% of cases without clinically suspicious nodes at levels IV or V had pathological metastasis.
• Nodal staging above N2b was significantly associated with higher metastasis rates to levels IV or V (p=0.025).
• Selective ND with adjuvant therapy showed comparable regional control and survival to comprehensive ND in cN2a OSCC patients.

Conclusions:

• Levels IV and V can potentially be excluded in therapeutic ND for cN+ OSCC patients staged cN2a.
• Selective ND, when combined with appropriate adjuvant therapy, offers comparable oncological outcomes for selected patients.
• This finding may help refine surgical management strategies for OSCC neck metastasis.