Health-related quality of life in patients with T1N0 oral squamous cell carcinoma: selective neck dissection compared with wait and watch surveillance

Abstract

There are controversies in the management of the neck in clinical T1N0 oral squamous cell carcinoma (OSCC). The aim of this study was to describe a consecutive cohort of stage 1 OSCC patients and report their HRQOL at a time closest to two years after primary surgery. Of 216 patients treated between 2007-2012, 195 were eligible for the analysis of health related quality of life (HRQoL), after excluding early death and regional recurrence. This was measured using the University of Washington Quality of Life V4 questionnaire. Overall response was 65% (126/195). The HRQoL outcomes were good. However, there were more clinically significant problems for patients in the SND group than W&W in appearance (14% Vs 1%, P=0.008) and pain (19% Vs 6%, P=0.04). Similar trends were seen for shoulder (14% Vs 8%), mood (16% Vs 8%) and speech (5% Vs 1%) and for overall quality of life being less than good (30% Vs 16%). It is difficult to tease out why patients did or did not have neck dissection in a retrospective sample, but it is likely that those with SND could have had larger stage 1 tumours. The findings highlight the importance of SND on HRQOL in domains such as appearance, pain, speech, swallowing and chewing. Previous studies in SND have tended to focus on accessory nerve injury and shoulder function, however this new data emphasises the need to include other domains in future trials comparing W&W, SND and sentinel lymph node biopsy. *Mann-Whitney test for subscale scores and Fishers Exact test for overall QOL. **Physical function subscale scores known for N=88

Accuracy of 18-F Fluorodeoxyglucose Positron Emission Tomographic/Computed Tomographic Imaging in Primary Staging of Squamous Cell Carcinoma of the Oral Cavity

“…The high and superior NPV for the respective cervical sides (94.0%) and levels (98.3%) should be considered before surgery to optimize neck dissection, which is important because the dissection of lymph node metastases leads to an increase in the likelihood of survival, 38 whereas elective neck dissection is accompanied by poorer health-related quality of life. 20,[39][40][41] A more reliable estimation of lymphogenic metastases thus results in increased quality of life.…”

How is neck dissection performed in Oral and Maxillofacial Surgery? Results of a representative nationwide survey among university and non-university hospitals in Germany

“…The benefit of modified radical ND in advanced nodal disease (N2, N3) in OSCC is controversially discussed [ 17 ]. One reason for this controverse discussion is that ND has been reported to have a significant influence on health-related quality of life of the patients, e.g., regarding appearance and pain [ 18 ]. In this context, some authors consider sentinel lymph node (SLN) biopsy as a minimal form of ND, picking one single or a few specific, radionucleotide-labeled lymph nodes in OSCC as a substitute for ND [ 19 ].…”

Radiotherapy as Elective Treatment of the Node-negative Neck in Oral Squamous Cell Cancer

“…Complications after neck dissection include short-term complications such as bleeding, seroma, chylous fistula, infection, and post-operative pain, as well as long-term complications most often related to nerve damage. The marginal branch of the facial nerve and the spinal accessory nerve are particularly exposed to damage, leading to impaired function of the depressor muscle and the trapezius muscle, respectively (33)(34)(35). In most cases of END, the ipsilateral submandibular gland is removed.…”