Elective neck dissection in oral and oropharyngeal cancer

Elective neck dissection of clinically negative neck nodes at the time of removal of the primary tumour may result in reduced locoregional recurrence, but the evidence is insufficient about it's effect on survival as compared to therapeutic neck dissection. Radical neck dissection probably has no effect on survival compared to conservative neck dissection surgery.

A Cochrane review included 7 trials with 669 patients. A total of 667 patients had cancers of the oral cavity. Trials were grouped into three main comparisons.

• Elective neck dissection versus therapeutic delayed neck dissection (4 trials, n=319) in patients with oral cavity cancer and clinically negative neck nodes: differences in type of surgery and duration of follow-up made meta-analysis inappropriate. Three trials reported overall and disease free survival. One trial showed a benefit for elective supraomohyoid neck dissection compared to therapeutic ND in overall and disease free survival. Two trials found no difference between elective radical ND and therapeutic ND for the outcomes of overall survival and disease free survival. All four trials found reduced locoregional recurrence following elective ND.
• Radical neck dissection versus selective neck dissection (2 trials, n=315): no difference in overall survival, disease free survival or recurrence.
• Radiotherapy plus surgery versus radiotherapy alone (one trial, n=35) the data were unreliable because the trial stopped early and there were multiple protocol violations.

Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment) and by imprecise results (limited study size for each comparison).

Ədəbiyyat

1. Bessell A, Glenny AM, Furness S et al. Interventions for the treatment of oral and oropharyngeal cancers: surgical treatment. Cochrane Database Syst Rev 2011;(9):CD006205.