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Topic: State of the Art in the Management of Oral Squamous Cell Carcinoma

Elective neck dissection in early oral

squamous cell carcinoma: necessary?

Carlos Moreno-García

Department of Oral and Maxillofacial-Head and Neck Surgery, University Hospital Infanta Cristina, 06080 Badajoz, Spain.
Corresponding author: Dr. Carlos Moreno-García, Department of Oral and Maxillofacial-Head and Neck Surgery, University Hospital Infanta
Cristina Ctra de Portugal, 06080 Badajoz, Spain. E-mail: carlosmorenogar@gmail.com

Dr. Carlos Moreno-García, M.D., obtained his Medical Degree at the University of Extremadura School of Medicine
in Badajoz, Spain, in 1999. He received in 2003 his Specialty in Family and Community Medicine at the Teaching
Unit of the La Paz Health Center in Badajoz, Spain, and his Specialty in Oral and Maxillofacial Surgery at the
University Hospital Infanta Cristina, Badajoz, Spain in 2009. He has been consultant at the Department of Oral and
Maxillofacial Surgery in University Hospital Infanta Cristina, Badajoz, Spain, since then. Actually, he is University
Honorary Collaborator at the University of Extremadura School of Medicine, Badajoz, Spain.

ABSTRACT
Aim: The indication of neck dissection in oral squamous cell carcinoma (OSCC) is a problem of risk-benefit
evaluation between probability of neck metastases, the problem of complications associated with neck dissection
and the prognostic influence of delayed diagnosis of metastasis during follow-up. There is no consensus on
the elective treatment of the neck in early oral cancer patients with a clinically N0 (cN0) neck. Methods: The
author performed a search of PubMed articles with the words "elective neck dissection vs. observation", "node
negative neck" and "early stage oral squamous cell carcinoma". The author selected those articles that studied
the early OSCC (T1-T2), and elective neck treatment was compared with clinical observation. Results: Many
studies have compared the outcome of elective neck dissection (END) to observation of the neck in early
OSCC. The results of them are described. The biologic aggressiveness of oral cavity squamous cell carcinoma,
particularly in the early stages, is reflected in its ability to metastasize to regional lymph node chains. Many
pretreatment imaging techniques to diminish the incidence of occult metastases haven been studied, and
comparative studies have shown ultrasound guided fine needle aspiration cytology (USgFNAC) to be the
most accurate. Conclusion: A few non-randomized studies have shown no advantages of END when
strict USgFNAC follow-up was employed. Thus, if routine strict follow-up using USgFNAC by a well-
trained ultrasonographer cannot be assured, END is the safest strategy.

Key words:
Early stage; oral squamous cell carcinoma; negative lymph necknode; elective neck dissection versus
observation

INTRODUCTION with head and neck squamous cell cancer is the status
of the cervical lymph node. [1-5] Patients with lymph node
Management of the clinically negative neck in patients with metastases require treatment of the neck. When the neck
T1-T2 oral cancer remains controversial [Figure 1]. The single This is an open access article distributed under the terms of the Creative Commons
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How to cite this article: Moreno-García C. Elective neck dissection
in early oral squamous cell carcinoma: necessary? Plast Aesthet
DOI: Res 2016;3:167-74.
10.20517/2347-9264.2016.12
Received: 29-03-2016; Accepted: 17-05-2016
© 2016 Plastic and Aesthetic Research | Published by OAE Publishing Inc. 167