Elective neck dissection versus observation in squamous cell carcinoma of oral cavity with clinically N0 neck: A systematic review and meta-analysis of prospective studies

Publication date: Available online 22 August 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Zhangfan Ding, Tingying Xiao, Jie Huang, Yihang Yuan, Qingsong Ye, Ming Xuan, Huixu Xie, Xiaoyi Wang

Abstract

Purpose

To assess the possible benefits of elective neck dissection (END) in patients with squamous cell carcinoma (SCC) of oral cavity and clinically N0 neck.

Methods

MEDLINE, Embase, China National Knowledge Infrastructure, and Wan Fang Database were systematically searched. A meta-analysis was performed to evaluate the possible benefits of END to such patients.

Results

A total of 6 prospective studies involving 865 subjects fulfilled the inclusion criteria. The meta-analysis of all included studies revealed that END reduced the risk of regional recurrences significantly (RR 0.27; 95% CI 0.21-0.36) in the fixed effect model compared with the control, observation only. Three of the 6 included studies showed that the specific death rate related to regional recurrences was lower in END group than the observation group in the fixed effect model (RR 0.35; 95% CI 0.19-0.65). The mean metastasis rate of occult cervical lymph node was 30.27% with the standard deviation (SD) of 9.42. When fixed effect model was applied, four of the 6 included studies showed a less recurrence in END group compared with the observation group(RR 0.53; 95% CI 0.44-0.64).

Conclusions

END significantly reduces the recurrences and the death related to regional recurrences in early-stage SCC of oral cavity with clinically N0 neck, especially SCC of oral tongue and floor of mouth, which is necessary for such patients.

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