Elective Neck Dissection Versus Observation in Early‐Stage (cT1/T2N0) Oral Squamous Cell Carcinoma

Abstract

Objectives Whether to perform elective neck dissection (END) or apply the observation (OBS) policy in patients with early‐stage oral squamous cell carcinoma (OSCC) without clinical evidence of cervical lymph node metastasis (cT1/T2N0) remains uncertain. The two most recent meta‐analyses include many studies published before the widespread availability of CT scanning in the 1990s. With the rapid advancement in imaging studies since 1990, the early clinical detection of cervical node metastasis has become more reliable without the need for END or pathological staging. Thus, we conducted a systematic review and meta‐analysis of studies comparing survival outcomes between END and OBS in patients with cT1/T2N0 OSCC. Methods We performed a systematic search of MEDLINE, PubMed, and Scopus for retrospective and prospective studies published between January 1, 1990, and January 1, 2018, comparing clinical outcomes between END and OBS in patients with cT1/T2N0 OSCC. Information on population characteristics, study design, overall survival (OS), disease‐specific survival (DSS), and disease‐free survival (DFS) was extracted and estimated. Effect measures for outcomes were hazard ratios (HRs) and 95% confidence intervals (CIs). Results Thirteen retrospective and two prospective randomized studies (3,158 patients) met the inclusion criteria. Compared to OBS, END failed to significantly improve OS (HR, 1.02; 95% CI, 0.95–1.09; P = .77; fixed‐effects model), DSS (HR, 1.07; CI, 1.02–1.13; P = .31; fixed‐effects model), and DFS (HR, 0.86; CI, 0.72–1.01; P = .12; random‐effects model). Conclusions Our findings indicate that in patients with cT1T2N0 OSCC, the OBS policy can yield markedly similar OS, DSS, and DFS to those resulting from END. Level of Evidence 2

Variability in Recommendations for Cervical Lymph Node Pathology for Staging of Canine Oral Neoplasia: A Survey Study

“…Critics of END in human oncology focus on the potential over-treatment argument and highlight that a large percentage of patients with clinically N0 neck assessment undergo unnecessary surgery, and it is not always clear that benefits outweigh the postoperative morbidity ( 21 , 24 , 26 ). Risks associated with END include prolonged anesthesia time, and postoperative changes including neck pain, fibrosis, reduced shoulder mobility and strength, and nerve damage, all of which can negatively affect patient quality-of-life measures ( 24 , 32 , 37 , 38 ). As rapid advances in CT, MRI, and PET technology better detect nodal changes during cancer staging, it is possible that close observation with salvage neck dissection, defined as removing bulky metastatic disease at the time of nodal progression, may yield similar outcomes to END ( 24 ).…”

“…Risks associated with END include prolonged anesthesia time, and postoperative changes including neck pain, fibrosis, reduced shoulder mobility and strength, and nerve damage, all of which can negatively affect patient quality-of-life measures ( 24 , 32 , 37 , 38 ). As rapid advances in CT, MRI, and PET technology better detect nodal changes during cancer staging, it is possible that close observation with salvage neck dissection, defined as removing bulky metastatic disease at the time of nodal progression, may yield similar outcomes to END ( 24 ).…”

Significance of SUV Max for Predicting Occult Lymph Node Metastasis and Prognosis in Early-Stage Tongue Squamous Cell Carcinoma

“…Owing to the various lymph node metastasis phenomena, there is great controversy regarding the neck management of cT1-2N0 disease patients. Researchers who support routine neck dissection describe that it can select patients who need adjuvant radiotherapy and then improve survival [1,2], but others argue that most patients with cT1-2N0 disease do not have pathologic lymph node metastasis; they are overtreated and exposed to possible neck dissectionrelated complications [3,4]. erefore, it is important for us to identify reliable predictors of neck lymph node metastasis, and current evidence supports the predictive value of depth of invasion (DOI), perineural invasion (PNI), and lymphovascular invasion (LVI).…”

Comparison Between PET-CT–Guided Neck Dissection and Elective Neck Dissection in cT1-2N0 Tongue Squamous Cell Carcinoma

“…Tongue squamous cell carcinoma (SCC) is the most common malignancy in the oral cavity, and surgery is usually the first choice of treatment. For cT1-2N0 tongue SCC, its occult metastasis rate varies with different countries and races (1)(2)(3). Usually, neck dissection is required if the metastasis rate is greater than 20%.…”

“…Usually, neck dissection is required if the metastasis rate is greater than 20%. Although current high-quality research has described that routine neck dissection improves the prognosis by distinguishing patients who need adjuvant radiotherapy (1,4,5), researchers argue that most patients with cT1-2N0 disease do not have pathologic lymph node metastasis, and they are over-treated and exposed to possible neck dissection-related complications (2,3); more importantly, the survival benefit associated with routine neck dissection could be contributed to by the late treatment of the metastatic necks at initial treatment. Owing to the development of individualized treatment concepts, it is very important for us to identify patients with pathologic lymph node metastasis preoperatively to achieve both oncologic and functional outcomes.…”