Abstract
The clinically node negative neck in early oral cancers amenable to per oral excision was addressed by a wait and watch policy followed by a therapeutic neck dissection in patients that developed nodal metastasis or with elective neck dissection. With lack of conclusive evidence for or against either approach, there was no consensus with regards optimum management of these patients. Recent Level I evidence by way of a large randomized trial as well as two subsequent meta-analysis conclusively show benefit in favour of elective neck treatment in the vast majority of patients. Preoperative imaging and tumour factors that possibly could identify patients at high risk of metastasis have their limitations. Early detection of nodal metastasis with possibility of salvage with a wait and watch approach is also ineffective. Elective neck dissection should be the standard of care in this clinical situation given compelling survival advantage in its favour.
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References
Werning JW, Heard D, Pagano C, Khuder S. Elective management of the clinically negative neck by otolaryngologists in patients with oral tongue cancer. Arch Otolaryngol Head Neck Surg. 2003;129(1):83–8.
Dünne AA, Folz BJ, Kuropkat C, Werner JA. Extent of surgical intervention in case of N0 neck in head and neck cancer patients: an analysis of data collection of 39 hospitals. Eur Arch Otorhinolaryngol. 2004;261(6):295–303.
Vandenbrouck C, Sancho-Garnier H, Chassagne D, Saravane D, Cachin Y, Micheau C. Elective versus therapeutic radical neck dissection in epidermoid carcinoma of the oral cavity: results of a randomized clinical trial. Cancer. 1980;46:386–90.
Fakih AR, Rao RS, Borges AM, Patel AR. Elective versus therapeutic neck dissection in early carcinoma of the oral tongue. Am J Surg. 1989;158:309–13.
Kligerman J, Lima RA, Soares JR, Prado L, Dias FL, Freitas EQ, et al. Suprahyoid neck dissection in the treatment of T1/T2 squamous cell carcinoma of oral cavity. Am J Surg. 1994;168:3.
Yuen AP, Ho CM, Chow TL, Tang LC, Cheung WY, Ng RW, et al. Prospective randomized study of selective neck dissection versus observation for N0 neck of early tongue carcinoma. Head Neck. 2009;31(6):765–71.
Fasunla AJ, Greene BH, Timmesfeld N, Wiegand S, Werner JA, Sesterhenn AM. A meta-analysis of the randomized controlled trials on elective neck dissection versus therapeutic neck dissection in oral cavity cancers with clinically node-negative neck. Oral Oncol. 2011;47(5):320–4.
D’Cruz AK, Dandekar MR. Elective versus therapeutic neck dissection in the clinically node negative neck in early oral cavity cancers: do we have the answer yet? Oral Oncol. 2011;47(9):780–2.
D’Cruz AK, Vaish R, Kapre N, et al. Elective versus therapeutic neck dissection in node-negative oral cancer. N Engl J Med. 2015;373(6):521–9.
Ren Z-H, Xu J-L, Li B, Fan T-F, Ji T, Zhang C-P. Elective versus therapeutic neck dissection in node-negative oral cancer: evidence from five randomized controlled trials. Oral Oncol. 2015;51(11):976–81.
Abu-Ghanem S, Yehuda M, Carmel NN, et al. Elective neck dissection vs observation in early-stage squamous cell carcinoma of the oral tongue with no clinically apparent lymph node metastasis in the neck: a systematic review and meta-analysis. JAMA Otolaryngol Head Neck Surg. 2016;142(9):857–65.
Paleri V, Rees G, Arullendran P, Shoaib T, Krishman S. Sentinel node biopsy in squamous cell cancer of the oral cavity and oral pharynx: a diagnostic meta-analysis. Head Neck. 2005;27(9):739–47.
Govers TM, Hannink G, Merkx MA, Takes RP, Rovers MM. Sentinel node biopsy for squamous cell carcinoma of the oral cavity and oropharynx: a diagnostic meta-analysis. Oral Oncol. 2013;49(8):726–32.
Liu M, Wang SJ, Yang X, Peng H. Diagnostic efficacy of sentinel lymph node biopsy in early oral squamous cell carcinoma: a meta-analysis of 66 studies. PLoS One. 2017;12(1):e0170322.
Teymoortash A, Hoch S, Eivazi B, Werner JA. Postoperative morbidity after different types of selective neck dissection. Laryngoscope. 2010;120(5):924–9.
Andersen PE, Cambronero E, Shaha AR, Shah JP. The extent of neck disease after regional failure during observation of the N0 neck. Am J Surg. 1996;172(6):689–91.
D’Cruz A, Vaish R, Gupta S, et al. Does addition of neck ultrasonography to physical examination, in follow-up of patients with early stage, clinically node negative oral cancers, influence outcome? A randomized control trial (RCT). J Clin Oncol. 2016;34(15_Suppl):6020. https://doi.org/10.1200/JCO.2016.34.15_suppl.6020.
van den Brekel MW, Castelijns JA, Reitsma LC, Leemans CR, van der Waal I, Snow GB. Outcome of observing the N0 neck using ultrasonographic-guided cytology for follow-up. Arch Otolaryngol Head Neck Surg. 1999;125(2):153–6.
Weiss MH, Harrison LB, Isaacs RS. Use of decision analysis in planning a management strategy for the stage NO neck. Arch Otolaryngol Neck Surg. 1994;120(7):699–702.
Schilling C, Stoeckli SJ, Haerle SK, Broglie MA, Huber GF, Sorensen JA, et al. Sentinel European Node Trial (SENT): 3-year results of sentinel node biopsy in oral cancer. Eur J Cancer. 2015;51(18):2777–84.
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D’Cruz, A.K., Dhar, H., Vaish, R. (2019). Elective Versus Therapeutic Neck Dissection for Clinically Node Negative Early Oral Cancer. In: Gooi, Z., Agrawal, N. (eds) Difficult Decisions in Head and Neck Oncologic Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-030-15123-2_1
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