Consensus on resectability in N3 head and neck squamous cell carcinomas: GETTEC recommendations

Area of Science:

• Oncology
• Surgical Oncology
• Head and Neck Surgery

Background:

• Upfront neck dissection improves oncological outcomes for T0-2 N3 head and neck squamous cell carcinomas (HNSCC).
• Lack of a consensus definition for N3 node resectability leads to treatment inconsistencies and biased study interpretations.
• Establishing a consensus on resectability is vital for decision-making in N3 HNSCC management.

Purpose of the Study:

• To establish a consensus definition for the resectability of N3 nodes in head and neck squamous cell carcinomas (HNSCC).
• To define criteria impacting the decision-making process for upfront neck dissection in N3 HNSCC patients.

Main Methods:

• A Delphi method was employed, involving head and neck surgeons from university hospitals and cancer centers.
• A 24-item questionnaire was used to achieve strong and relative agreements on resectability criteria.
• Recommendations were formulated and subsequently assessed by 30 independent surgeons.

Main Results:

• Major contraindications for neck dissection include intraparenchymal brain invasion, foramen invasion, skull base erosion, bilateral XIIth cranial nerve sacrifice, retropharyngeal N3 nodes, or nodes above the soft palate.
• Unilateral sacrifice of cranial nerves IX, X, or XII, or cervical nerve roots, may permit upfront neck dissection based on case-by-case evaluation.
• Consensual contraindications identified were skull base invasion, retropharyngeal nodes, and bilateral XIIth cranial nerve sacrifice.

Conclusions:

• A consensus was reached among French head and neck surgeons regarding contraindications for neck dissection in T0-2 N3 HNSCC.
• This consensus aims to enhance the reliability of comparisons between surgical and non-surgical treatment strategies for N3 HNSCC patients.