gms | German Medical Science

Introduction: The optimal elective neck treatment in patients with oropharyngeal carcinoma (OPSCC) with clinically node-negative neck (cN0) is still controversially

discussed. In order to assess the value of elective neck dissection (END) for regional control and survival in OPSCC patients, a retrospective patients’ chart review and a systematic review of literature was performed.

Methods and patients: The retrospective chart review yielded 49 OPSCC patients staged cT1–3 cN0, who had undergone surgical resection of the primary and either END (n=32) or observation (n=17) of the neck. For the systematic review of literature, Pubmed and EMBASE were searched for clinical studies including data on both END and observation of the neck in OPSCC patients staged cN0.

Results: The statistical analysis did not reveal significant differences for any of the outcomes considered. The estimated 5-year overall-survival rate was 82% for END and 76% for observation (HR=1.01; CI=0.44-2.27). The estimated 5-year disease-free survival rate was 78% for END and 67% for observation (HR=1.79 CI=0.57-5.56); the 5-year disease-specific survival rate was 97% (END) and 81% (observation) (HR=2.22; CI=0.49-10). The systematic review of literature yielded only retrospective chart reviews and no data meeting our selection criteria for further data analysis.

Conclusion: Due to a lack of high-grade evidence, the decision for elective neck dissection in cN0 OPSCC remains a therapeutic challenge and continues to be based on the preference of the individual surgeon. The demonstrated clinical equipoise is a good basis for a multicentric, randomized trial.