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Elective Neck Dissection in Advanced Cutaneous Head and Neck Squamous Cell Carcinoma: Systematic Review and
Seraphina Key1, Matthew Kwok1, Timothy McLean1
1Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.
Elective neck dissection (END) for head and neck cutaneous squamous cell carcinoma (cSCC) in node-negative patients does not conclusively improve survival. Further research is needed to clarify the role of END in managing advanced cSCC.
Area of Science:
- Oncology
- Surgical Oncology
- Head and Neck Surgery
Background:
- Locally advanced cutaneous squamous cell carcinoma (cSCC) of the head and neck presents a complex management challenge.
- The role of elective neck dissection (END) in clinically node-negative (cN0) patients with advanced cSCC remains unclear.
- Existing literature lacks a comprehensive systematic review on the impact of END on survival outcomes in this specific patient group.
Purpose of the Study:
- To systematically review and meta-analyze the existing evidence on the role of END in cN0 locally advanced head and neck cSCC.
- To determine if END improves overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) compared to observation.
- To assess the occult cervical nodal metastasis rate in this patient population.
Main Methods:
- A systematic review and meta-analysis of studies published from inception to June 22, 2025, was conducted.
- Searches included MEDLINE, Embase, Scopus, ClinicalTrials.gov, ANZCTR, and grey literature.
- Inclusion criteria focused on END versus observation in cN0 locally advanced head and neck cSCC, with OS, DSS, and DFS as primary outcomes.
Main Results:
- Six studies involving 522 patients (197 with END, 325 observed) were included.
- Meta-analysis for 5-year OS did not yield a conclusive result regarding the benefit of END.
- The occult cervical nodal metastasis rate was found to be 17.34% (95% CI 10.57 to 25.14).
Conclusions:
- Current evidence does not conclusively support improved overall survival (OS) or disease-specific survival (DSS) with elective neck dissection (END) in locally advanced cSCC.
- The study highlights a significant rate of occult nodal metastasis, underscoring the complexity of treatment decisions.
- Further high-quality research is necessary to definitively establish the role and benefit of END in cN0 locally advanced head and neck cSCC.
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