Elective Neck Dissection Versus Therapeutic Neck Dissection in Clinically Node-Negative Early Stage Oral Cancer: A...

Area of Science:

• Oncology
• Surgical Oncology
• Head and Neck Cancer

Background:

• Oral squamous cell carcinoma (OSCC) presents a high risk of cervical lymph node metastasis.
• The optimal management for clinically node-negative (N0) early-stage OSCC remains debated: elective neck dissection (END) versus observation (OBS) with delayed therapeutic dissection.

Purpose of the Study:

• To compare the efficacy of elective neck dissection (END) versus observation (OBS) in patients with early-stage oral squamous cell carcinoma (OSCC) and a clinically node-negative (N0) neck.
• To evaluate the impact on survival and lymph node recurrence rates through a meta-analysis of randomized controlled trials (RCTs).

Main Methods:

• A systematic meta-analysis was conducted on randomized controlled trials (RCTs) comparing END and OBS for early-stage OSCC with N0 neck.
• PubMed and Scopus databases were searched for relevant English-language studies.
• Random effects models were used to calculate hazard ratios (HR) for survival and odds ratios (OR) for recurrence.

Main Results:

• The meta-analysis included 7 RCTs with 1250 patients.
• Elective neck dissection (END) significantly improved overall survival (HR 0.67) and disease-free survival (HR 0.64) compared to observation (OBS).
• END significantly reduced lymph node recurrence (OR 0.28) and improved disease-specific survival (HR 0.53) after heterogeneity correction.

Conclusions:

• Elective neck dissection (END) in clinically node-negative early-stage oral cancer patients reduces nodal recurrence.
• END confers a significant survival benefit for patients with early-stage oral cancer and a N0 neck.
• The findings support the routine use of END in this patient population.