What is the role of elective neck dissection in the management of patients with buccal squamous cell carcinoma and a clinically negative neck?

Publication date: Available online 7 November 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Jasjit K. Dillon, Akashdeep S. Villing, Richard S. Jones, Neal D. Futran, Hans C. Brockhoff, Eric R. Carlson, Thomas Schlieve, Deepak Kademani, Ketan Patel, Scott T. Claiborne, Eric J. Dierks, Yedeh P. Ying, Brent B. Ward

Abstract

Purpose

Buccal squamous cell carcinoma (BSCC) is rare in the United States. Given its location, few anatomical barriers to spread exist and it has been found to have a high loco-regional recurrence rate^1,2. The role of the elective neck dissection (END) in the clinically negative neck (N0) is not clear. This study aims to answer the research question: Among patients with N0 BSCC does END improve loco-regional control, distant metastatic rates, and 2 and 5 year survival rates?

Methods

A retrospective cohort study was conducted. The sample included subjects diagnosed with BSCC. The primary predictor variable was END status (yes/no). 5 institutions participated: The Universities of Washington, Michigan, Tennessee, North Memorial Oral and Maxillofacial Surgery in Minnesota and Head and Neck Surgical Associates (Portland, OR) between June 2001 and June 2011. The primary outcome variable was loco-regional recurrence. Secondary outcome variables were distant metastasis, 2 and 5 year survival rates. Other variables collected were demographics, initial operation, adjuvant therapy, clinical and pathology data and staging. Kaplan-Meier and Cox proportional hazards statistics were computed.

Results

The sample was composed of 98 subjects with clinically N0 BSCC. The mean age was 66 (30-88), and 54% were male. 74 (76%) underwent END. Loco-regional recurrence-free rates were 61% for END versus 38% for no END (p=0.042). Distant metastatic rates were 4% for END versus 9% for no END. The 2- and 5-year disease-free survival rates were 91 and 75% (p=0.042),respectively, for END and 85 and 63% (p= 0.019), respectively,for no END.

Conclusion

END had a therapeutic effect, evidenced by lower loco-regional recurrence, distant metastatic rates and improved 2 and 5 year survival.

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