Matched-pair analysis of the outcome of two different neck dissection techniques for oral squamous cell carcinoma

This study aimed to compare two different neck dissection (ND) techniques, conventional ND (CND) and functional ND (FND), in terms of lymph node yield (LNY) and regional recurrence (RR). FND is a concept based on dissection along the cervical fascial planes with en bloc removal of cervical lymph node levels (LNLs) while preserving the neurovascular and muscular structures, as described by Osvaldo Suárez. In contrast, CND involves the separate division of LNLs in situ without targeting the fascial planes.

This retrospective cohort study included previously untreated patients who underwent surgery at our institution between January 2019 and December 2023. Of the 253 patients, 201 underwent CND, and 52 underwent FND. Propensity score matching selected 52 CND patients to be matched to the FND group based on the following variables: age, body mass index, tumor localization, tumor size, vascular invasion, lymphatic involvement, and perineural invasion. Although the nodal stage (UICC-pN) was not included in the matching process, it was assessed as a study endpoint.

The mean LNY was significantly higher in the FND group (55 vs. 44 nodes; p = 0.016). After a mean follow-up of 42 months (range, 12-60), RR occurred in 3.8% (n = 2) of patients in the FND group and 10.4% (n = 5) in the CND group (p = 0.198).

In the present cohort, FND achieved a significantly higher LNY while maintaining comparable regional control, underscoring its potential as an oncologically sound approach, albeit within the constraints of a retrospective, underpowered study.