# Elective vs therapeutic neck dissection in node-negative oral cancer (Tata Memorial)

Source: https://onco.cc/trials/elective-neck-dissection-tmh/  
OnCo record `elective-neck-dissection-tmh` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A Tata Memorial trial ended a 50-year debate by showing that removing the neck lymph nodes at the first operation for early mouth cancer raises three-year survival from about two-thirds to four-fifths.

## Summary

596 patients were enrolled and 500 analysed (245 elective, 255 therapeutic) with a median follow-up of 39 months. There were 81 recurrences and 50 deaths with elective dissection against 146 recurrences and 79 deaths with therapeutic dissection; 3-year overall survival was 80.0% versus 67.5% (hazard ratio 0.64; 95% CI 0.45-0.92; P=0.01) and disease-free survival 69.5% versus 45.9% (P<0.001), with adverse events in 6.6% versus 3.6%. Presented in the ASCO plenary and published in NEJM, it changed guidelines worldwide and showed that Indian centres, with their very large oral cancer volumes, can settle questions Western centres cannot.

## Fields

- Kind: Trial
- Status: positive
- Last checked: 2026-09-10
- Registry id: NCT00193765
- Phase: 3
- Setting: Early-stage (T1-T2) node-negative oral squamous cell cancer: elective neck dissection at primary surgery vs watchful waiting with therapeutic dissection at nodal relapse
- Sponsor: Tata Memorial Centre
- Enrolled: 596
- Result: 3-year OS 80.0% vs 67.5% (HR 0.64); DFS 69.5% vs 45.9%.
- Outcomes: 3-year overall survival: Elective neck dissection 80% vs Therapeutic neck dissection 67.5%, HR 0.64

## Sources

- ClinicalTrials.gov NCT00193765: https://clinicaltrials.gov/study/NCT00193765
- D'Cruz et al., NEJM 2015: https://doi.org/10.1056/NEJMoa1506007

## Connected records

- cancers: [Buccal mucosa and gingivobuccal cancer (oral cancer in India)](https://onco.cc/cancers/buccal-mucosa-cancer/), [Head and neck squamous cell carcinoma](https://onco.cc/cancers/head-and-neck/), [Oral cavity cancer (mouth and tongue)](https://onco.cc/cancers/oral-cavity-cancer/), [Oral tongue and floor of mouth cancer](https://onco.cc/cancers/oral-tongue-cancer/)
- technologies: [Sentinel lymph node biopsy](https://onco.cc/technologies/sentinel-node/)
- institutions: [Tata Memorial Centre](https://onco.cc/institutions/tata-memorial/)
- terms: [Overall survival (OS)](https://onco.cc/terms/os/)
- people: [Anil K. D'Cruz](https://onco.cc/people/dcruz-anil/)
- bottlenecks: [Surgery and radiotherapy cure most, get least](https://onco.cc/bottlenecks/b-surgery-radiation-innovation/)
- key papers: [Elective versus therapeutic neck dissection in node-negative oral cancer](https://onco.cc/key-papers/paper-dcruz-elective-neck-dissection-nejm-2015/)
- roadmaps: [Global access and affordability roadmap: essential medicines and generics → biosimilars and frugal trials → reliance, pooling and homegrown innovation](https://onco.cc/roadmaps/global-access-roadmap/), [Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work](https://onco.cc/roadmaps/surgery-roadmap/)

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