What Is the Role of Elective Neck Dissection in the Treatment of Patients With Buccal Squamous Cell Carcinoma and Clinically Negative Neck Findings?

Abstract

Buccal squamous cell carcinoma (BSCC) is rare in the United States. Given its location, few anatomic barriers to its spread exist, and it has been found to have a high locoregional recurrence rate. The role of elective neck dissection (END) in the clinically negative neck (N0) is not clear. In the present study, we measured the effect of END on the locoregional and distant metastasis rates among patients with clinically N0 BSCC. A retrospective cohort study was conducted. The sample included subjects diagnosed with BSCC. The primary predictor variable was END status (yes vs no). The primary outcome variable was locoregional recurrence. The secondary outcome variables were distant metastasis and the 2-and 5-year survival rates. Other variables collected included demographic data, initial operation, adjuvant therapy, pathologic data, and stage. Kaplan-Meier and Cox proportional hazards statistics were computed. The sample included 20 subjects with clinical N0 BSCC and a mean age of 67years (range 42-88); 55% were men. The disease stage was T1 in 30%, T2 in 40%, T3 in 15%, and T4 in 15%. Fifteen subjects underwent END. Of the 5 who had not undergone END, all 5 (100%) had locoregional recurrence and 1 (20%) had metastasis. Of the 15 who had undergone END, 5 (33%) had locoregional recurrence and 1(7%) had metastasis (P= .002). The 2- and 5-year survival rates for N0 patients without END was 80% and 40%, respectively, compared with 93% and 87% for those who had undergone END. END had a therapeutic role, resulting in a lower locoregional recurrence rate. Also, the 2-and 5-year survival rates were greater for those who had undergone END.