# Elective versus therapeutic neck dissection in node-negative oral cancer

Source: https://onco.cc/key-papers/paper-dcruz-elective-neck-dissection-nejm-2015/  
OnCo record `paper-dcruz-elective-neck-dissection-nejm-2015` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Removing the neck lymph nodes at the first operation for early mouth cancer, rather than waiting to see if they become involved, raised three-year survival from 67.5% to 80%.

## Summary

Randomised trial at Tata Memorial Hospital of 596 patients with early (T1-T2) node-negative oral squamous cell cancer, 500 analysed (245 elective, 255 therapeutic neck dissection), median follow-up 39 months. Elective dissection gave 81 recurrences and 50 deaths versus 146 and 79; 3-year overall survival 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); adverse events 6.6% versus 3.6%.

## Fields

- Kind: Key paper
- Last checked: 2026-09-10
- Journal: New England Journal of Medicine
- Year: 2015
- DOI: 10.1056/NEJMoa1506007
- Authors: D'Cruz AK, Vaish R, Kapre N, et al.
- Findings: 3-year overall survival 80.0% with elective neck dissection versus 67.5% with watchful waiting (HR 0.64).; 3-year disease-free survival 69.5% versus 45.9%.; Recurrences 81 versus 146; deaths 50 versus 79.; Adverse events were higher with elective dissection (6.6% versus 3.6%) but modest.
- What it means: Elective neck dissection is now the standard for early oral cancer everywhere. The trial shows what high-volume Indian centres can contribute: a definitive answer to a surgical question that had been debated for half a century and that Western centres, with far fewer oral cancers, could not resolve.
- Caveats: Ultrasound and clinical staging of the neck were used; modern imaging or sentinel node biopsy may change the trade-off.; Single-centre trial in a predominantly tobacco-related oral cancer population.; Quality of life and morbidity outcomes were secondary.

## Sources

- 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/)
- trials: [Elective vs therapeutic neck dissection in node-negative oral cancer (Tata Memorial)](https://onco.cc/trials/elective-neck-dissection-tmh/)
- 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/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

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