Elective versus therapeutic neck dissection in node-negative oral cancer
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%.
Overview
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%.
- 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.
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.
- 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.
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