Neck nodal recurrence and survival of clinical T1-2 N0 oral squamous cell carcinoma in comparison of elective neck dissection versus observation: A meta-analysis

OBJECTIVE: The clinical management of patients with T1-2 oral squamous cell carcinoma (OSCC) and clinically node-negative neck (cN0) continues to be controversial. We performed a systematic review of the literature to assess the effect of elective neck dissection (END) and neck observation (OBS) on the prognosis of patients with cT1-2 N0 OSCC. STUDY DESIGN: PubMed, Embase, and Cochrane Library were searched for studies related to END and OBS in patients with cT1-2 N0 OSCC. The Mantel-Haenszel method was used to pool odds ratios (OR) for neck nodal recurrence and hazard ratios (HR) for survival. RESULTS: END reduced the risk of neck nodal recurrence (OR 0.45; 95% confidence interval 0.32-0.63; P < .00001) in cT1-2 N0 OSCC. The disease-free survival (HR 0.52; 95% CI 0.42-0.63; P < .00001) was significantly higher in patients treated with END. However, END failed to significantly improve overall survival (HR 0.83; 95% CI 0.67-1.04; P = .10) and disease-specific survival (HR 0.87; 95% CI 0.48-1.57; P = .65) compared with management by OBS. CONCLUSIONS: A reduction in neck nodal recurrence and an increase in disease-free survival might support the need for END in early-stage OSCC with clinically N0 neck.