Elective Versus Therapeutic Neck Dissection for Clinically Node Negative Early Oral Cancer

Abstract

The clinically node negative neck in early oral cancers amenable to per oral excision was addressed by a wait and watch policy followed by a therapeutic neck dissection in patients that developed nodal metastasis or with elective neck dissection. With lack of conclusive evidence for or against either approach, there was no consensus with regards optimum management of these patients. Recent Level I evidence by way of a large randomized trial as well as two subsequent meta-analysis conclusively show benefit in favour of elective neck treatment in the vast majority of patients. Preoperative imaging and tumour factors that possibly could identify patients at high risk of metastasis have their limitations. Early detection of nodal metastasis with possibility of salvage with a wait and watch approach is also ineffective. Elective neck dissection should be the standard of care in this clinical situation given compelling survival advantage in its favour.