Management of Contralateral Neck Dissection in Ipsilateral Oropharyngeal Squamous Cell Cancer Cases

The incidence of oropharyngeal squamous cell carcinoma (OPSCC) is rising. Despite the better prognosis of HPV-associated disease, treatment protocols do not yet differentiate by HPV status. In patients with lateralized OPSCC with suspected ipsilateral lymph node metastases (LNM), contralateral neck management remains controversial. This study evaluated the necessity of elective contralateral neck dissection (ND) in patients with OPSCC.

Clinical and pathological data from patients treated surgically for OPSCC between 2000 and 2023 with bilateral ND at a single tumor center were analyzed retrospectively. Tumor stage was classified according to the 7^th and 8^th editions of the UICC tumor classification. All imaging studies were re-evaluated by the same board-certified senior radiologist to ensure consistency. Tumor laterality (lateral vs. crossing the midline) and LNM were classified. Radiological findings were correlated with histopathological results.

A total of 124 patients out of 467 were included (80.6% male; mean age 56.6 years). Tonsillar and base-of-tongue carcinomas accounted for 67.7% and 27.4% of cases respectively. In lateralized OPSCC (n=69), radiologically suspected LNM were present in 66 patients (sensitivity 95.6%), while contralateral occult LNM were confirmed histologically in only one case (1.4%, pT3 base of tongue carcinoma). In contrast, tumors extending/crossing the midline showed contralateral LNM in 47 of 55 patients (sensitivity 97.9%, specificity 42.9%). Survival was significantly lower in patients with contralateral metastases (p=0.046).

Elective contralateral ND appears unnecessary in most lateralized OPSCC without radiological evidence of contralateral metastasis. Precise preoperative imaging reliably identifies candidates for unilateral ND.