Oncological and quality-of-life outcomes after robotic versus open neck dissection in oral cavity cancer: a prospective matched-pair analysis

BACKGROUND: Neck dissection remains the standard of care for regional control of nodal disease in oral cavity squamous cell carcinoma, but the conventional trans-cervical approach leaves a visible scar and carries a recognized risk of shoulder morbidity. Remote-access robotic neck dissection has been proposed as a means of preserving oncological adequacy while improving cosmetic and functional outcomes. We report a prospective matched-pair comparison of retro-auricular robotic neck dissection and standard open neck dissection in patients with oral cavity cancer. METHODS: Sixty-four patients undergoing neck dissection for oral cavity carcinoma between January 2020 and December 2025 were enrolled and matched 1:1 by age, sex, tumour subsite and clinical stage; 32 underwent retro-auricular robotic neck dissection and 32 underwent conventional open neck dissection. Oncological adequacy was assessed by lymph node yield per dissection; quality of life and shoulder function were measured with the Neck Dissection Impairment Index (NDII); and cosmetic outcome was assessed with a structured patient-reported questionnaire. RESULTS: Mean lymph node yield was comparable between the robotic and open groups (23.9 vs 24.6 nodes per dissection; p = 0.542). Mean NDII scores at 3 weeks were similar (65.7 vs 64.2; p = 0.261) and improved over time in both groups. Patient-reported cosmetic satisfaction was significantly higher after robotic neck dissection (12.3 vs 8.0; p < 0.001). CONCLUSION: Retro-auricular robotic neck dissection achieves an oncological yield, quality-of-life and shoulder function outcome equivalent to open neck dissection, with a markedly superior cosmetic result, and merits consideration in appropriately selected patients with oral cavity cancer.