Abstract
Introduction The concept of selective neck dissection (SND) in locally advanced oral cancers is emerging. Contemporary studies support the feasibility of SND in selected node-positive oral cancers with early primaries. Nevertheless, the suitability of SND in clinically node-positive (cN+) oral cancers with advanced primaries (T3/T4) is unknown. Aim This study explores if patients with cN+ advanced primaries were suitable candidates for SND by spotting the involved lymph node distribution in various stations of the neck. Secondary objectives were to check if predictive clinicopathological factors for metastases to the neck in general also apply for lymph node metastases to levels IV and V. Methods The present retrospective study analysed the distribution of pathologically involved lymph nodes in 134 patients and explored the interrelation of various predictive factors and cervical metastases overall and those specific to levels IV and V. Results Level V was involved in 6.7% (6/83) of T4 and none of the T3 primaries. Depth of invasion (DOI), perineural invasion (PNI), and skin invasion were statistically significant predictors for nodal metastases in general on multivariate analysis. Conclusion Our analysis supports the option of considering SND, sparing level V in patients with cN+ oral cancers in a subset with T3 primary and nodal stage N2 and below.
Highlights
The concept of selective neck dissection (SND) in locally advanced oral cancers is emerging
The meta-analysis by Liang et al [4] showed no difference in regional recurrence, disease-specific survival, or overall survival for patients treated with comprehensive neck dissection (CND) or SND in patients with clinically node-positive oral cancers
5.2% of involved lymph nodes were in levels IV and V
Summary
The concept of selective neck dissection (SND) in locally advanced oral cancers is emerging. Aim. This study explores if patients with cN+ advanced primaries were suitable candidates for SND by spotting the involved lymph node distribution in various stations of the neck. The present retrospective study analysed the distribution of pathologically involved lymph nodes in 134 patients and explored the interrelation of various predictive factors and cervical metastases overall and those specific to levels IV and V. As nodal metastases to levels IV and V are rare in the absence of involvement of upper levels, an increasing number of studies have shown evidence for feasibility of SND even in some node-positive oral cancers [3]. The meta-analysis by Liang et al [4] showed no difference in regional recurrence, disease-specific survival, or overall survival for patients treated with CND or SND in patients with clinically node-positive (cN+) oral cancers
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